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