0001437749-12-010385.txt : 20121017
0001437749-12-010385.hdr.sgml : 20121017
20121017172020
ACCESSION NUMBER: 0001437749-12-010385
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20121016
FILED AS OF DATE: 20121017
DATE AS OF CHANGE: 20121017
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: WIT CORNELIS F
CENTRAL INDEX KEY: 0001238906
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 000-25203
FILM NUMBER: 121149029
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: OMNICOMM SYSTEMS INC
CENTRAL INDEX KEY: 0001034592
STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-BUSINESS SERVICES, NEC [7389]
IRS NUMBER: 113349762
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 2555 DAVIE ROAD
STREET 2: SUITE 110-B
CITY: FORT LAUDERDALE
STATE: FL
ZIP: 33317
BUSINESS PHONE: 954-473-1254
MAIL ADDRESS:
STREET 1: 2555 DAVIE ROAD
STREET 2: SUITE 110-B
CITY: DAVIE
STATE: FL
ZIP: 33317
FORMER COMPANY:
FORMER CONFORMED NAME: CORAL DEVELOPMENT CORP
DATE OF NAME CHANGE: 19970225
4
1
rdgdoc.xml
PRIMARY DOCUMENT
X0306
4
2012-10-16
0001034592
OMNICOMM SYSTEMS INC
OMCM
0001238906
WIT CORNELIS F
2101 W. COMMERCIAL BLVD.
SUITE 3500
FORT LAUDERDALE
FL
33309
1
1
Chief Executive Officer
Common Stock
2012-10-16
4
P
0
504413
0.149
A
4693238
D
Convertible Debenture
0.50
2012-10-16
4
P
0
250000
0.50
A
2012-10-16
2012-12-16
Common Stock
250000
64842517
D
Common Stock Warrants
0.50
2012-10-16
4
P
0
250000
0.50
A
2012-10-16
2012-12-16
Common Stock
250000
64092517
D
/s/ Cornelis F. Wit
2012-10-17