-----BEGIN PRIVACY-ENHANCED MESSAGE----- Proc-Type: 2001,MIC-CLEAR Originator-Name: webmaster@www.sec.gov Originator-Key-Asymmetric: MFgwCgYEVQgBAQICAf8DSgAwRwJAW2sNKK9AVtBzYZmr6aGjlWyK3XmZv3dTINen TWSM7vrzLADbmYQaionwg5sDW3P6oaM5D3tdezXMm7z1T+B+twIDAQAB MIC-Info: RSA-MD5,RSA, HxHOjVR3J+n12EYLTwBDc9J9P86yTH8l2wEGnsqQC0vGzlI3qnQhzqT4CE4WF3gD H365TrRO237UdReu5ERJUA== 0001010412-05-000360.txt : 20050927 0001010412-05-000360.hdr.sgml : 20050927 20050927114402 ACCESSION NUMBER: 0001010412-05-000360 CONFORMED SUBMISSION TYPE: SC 13D PUBLIC DOCUMENT COUNT: 1 FILED AS OF DATE: 20050927 DATE AS OF CHANGE: 20050927 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: OMNI MEDICAL HOLDINGS INC CENTRAL INDEX KEY: 0001085402 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-BUSINESS SERVICES, NEC [7389] IRS NUMBER: 870425275 STATE OF INCORPORATION: UT FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: SC 13D SEC ACT: 1934 Act SEC FILE NUMBER: 005-79236 FILM NUMBER: 051104539 BUSINESS ADDRESS: STREET 1: 1107 MT RUSHMORE ROAD STREET 2: SUITE 2 CITY: RAPID CITY STATE: SD ZIP: 57701 BUSINESS PHONE: 605 718 0380 MAIL ADDRESS: STREET 1: 1107 MT. RUSHMORE ROAD STREET 2: SUITE 2 CITY: RAPID CITY STATE: SD ZIP: 57701 FORMER COMPANY: FORMER CONFORMED NAME: PIEZO INSTRUMENTS INC DATE OF NAME CHANGE: 19990428 FILED BY: COMPANY DATA: COMPANY CONFORMED NAME: Davis Doug CENTRAL INDEX KEY: 0001320558 FILING VALUES: FORM TYPE: SC 13D BUSINESS ADDRESS: BUSINESS PHONE: 303-703-4507 MAIL ADDRESS: STREET 1: 2120 WEST LITTLETON BOULEVARD STREET 2: SUITE 100 CITY: LITTLETON STATE: CO ZIP: 80120 SC 13D 1 davis13d.txt UNITED STATES SECURITIES AND EXCHANGE COMMISSION WASHINGTON, D.C. 20549 SCHEDULE 13D UNDER THE SECURITIES EXCHANGE ACT OF 1934 Omni Medical Holdings, Inc. (Name of Issuer) COMMON STOCK, PAR VALUE $.001 PER SHARE. (Title of Class of Securities) 68214H101 (CUSIP Number) Doug Davis 2120 West Littleton Boulevard, Suite 100 Littleton, CO 80120 (303) 703-4507 -------------- (Name, Address and Telephone Number of Person Authorized to Receive Notices and Communications) March 1, 2005 (Date of Event which Requires Filing of this Statement) If the filing person has previously filed a statement on Schedule 13G to report the acquisition that is the subject of this Schedule 13D, and is filing this schedule because of Section 240.13d-1(e), 240.13d-1(f) or 240.13d-1(g), check the following box [_]. NOTE: Schedules filed in paper format shall include a signed original and five copies of the schedule, including all exhibits. See Section 240.13d-7 for other parties to whom copies are to be sent. The remainder of this cover page shall be filled out for a reporting person's initial filing on this form with respect to the subject class of securities, and for any subsequent amendment containing information which would alter disclosures provided in a prior cover page. The information required on the remainder of this cover page shall not be deemed to be "filed" for the purpose of Section 18 of the Securities Exchange Act of 1934 ("Act") or otherwise subject to the liabilities of that section of the Act but shall be subject to all other provisions of the Act (however, see the Notes). SCHEDULE 13D CUSIP NO. 68214H101 - ------------------------------------------------------------------------------ 1. NAME OF REPORTING PERSON S.S. OR I.R.S. IDENTIFICATION NO. OF ABOVE PERSON Doug Davis - ------------------------------------------------------------------------------ 2. CHECK THE APPROPRIATE BOX IF A MEMBER OF A GROUP (a) X (b) - ------------------------------------------------------------------------------ 3. SEC USE ONLY - ------------------------------------------------------------------------------ 4. SOURCE OF FUNDS OO (Stock Exchange) - ------------------------------------------------------------------------------ 5. CHECK BOX IF DISCLOSURE OF LEGAL PROCEEDINGS IS REQUIRED PURSUANT TO ITEMS 2(d) or 2(e) - ------------------------------------------------------------------------------ 6. CITIZENSHIP OR PLACE OF ORGANIZATION United States of America - ------------------------------------------------------------------------------ NUMBER OF SHARES BENEFICIALLY OWNED BY EACH REPORTING PERSON WITH 7. SOLE VOTING POWER 0 8. SHARED VOTING POWER 5,960,876 9. SOLE DISPOSITIVE POWER 0 10. SHARED DISPOSITIVE POWER 5,960,876 - ------------------------------------------------------------------------------ 11. AGGREGATE AMOUNT BENEFICIALLY OWNED BY EACH REPORTING PERSON 5,960,876 - ------------------------------------------------------------------------------ 12. CHECK BOX IF THE AGGREGATE AMOUNT IN ROW (11) EXCLUDES CERTAIN SHARES - ------------------------------------------------------------------------------ 13. PERCENT OF CLASS REPRESENTED BY AMOUNT IN ROW (11) 12.9% - ------------------------------------------------------------------------------ 14. TYPE OF REPORTING PERSON IN and OO - ----------------------------------------------------------------------------- SCHEDULE 13D ITEM 1. SECURITY AND ISSUER. Common stock of Omni Medical Holdings, Inc., 1107 Mount Rushmore Road, Suite 2, Rapid City, SD 57701. ITEM 2. IDENTITY AND BACKGROUND. JTA Group, 2120 West Littleton Boulevard, Suite 100, Littleton, Colorado 80120; Debra Contillo-Davis, Justin Davis, La Tessa Davis, Anthony Davis, all at the same address. (d) None. (e) None. (f) United States of America. ITEM 3. SOURCE AND AMOUNT OF FUNDS OR OTHER CONSIDERATION. Private funds. ITEM 4. PURPOSE OF TRANSACTION. None. ITEM 5. INTEREST IN SECURITIES OF THE ISSUER. (a) 5,960,876- 12.9 percent. Common stock- Doug Davis 2,086,307 shares; Debra Contillo-Davis 2,086,307 shares; Justin Davis 596,088 shares; La Tessa Davis 596,087 shares; Anthony Davis 596,087 shares. (b) 5,960,876- 12.9 percent. Common stock- Doug Davis 2,086,307 shares; Debra Contillo-Davis 2,086,307 shares; Justin Davis 596,088 shares; La Tessa Davis 596,087 shares; Anthony Davis 596,087 shares; must be unanimous. (c) None. (d) None. (e) Not Applicable. ITEM 6. CONTRACTS, ARRANGEMENTS, UNDERSTANDINGS OR RELATIONSHIPS WITH RESPECT TO SECURITIES OF THE ISSUER. None other than ownership. ITEM 7. MATERIAL TO BE FILED AS EXHIBITS. None; not applicable. SIGNATURE After reasonable inquiry and to the best of my knowledge and belief, I certify that the information set forth in this statement is true, complete and correct. Dated: 04/04/05 /s/ Douglas P. Davis - --------------------- Douglas P. Davis President and Managing Member -----END PRIVACY-ENHANCED MESSAGE-----