SEC FORM 5

SEC Form 5

FORM 5

UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

ANNUAL STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP

Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934
or Section 30(h) of the Investment Company Act of 1940

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Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).

Form 3 Holdings Reported.

Form 4 Transactions Reported.

1. Name and Address of Reporting Person^*

Ross Julian T

(Last)

(First)

(Middle)

C/O 10880 JOHN W. ELLIOT DRIVE

SUITE 600

(Street)

FRISCO

75033

(City)

(State)

(Zip)

2. Issuer Name and Ticker or Trading Symbol
OxySure Systems Inc [ OXYS ]

5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)

X	Director	X	10% Owner
X	Officer (give title below)		Other (specify below)
	CEO, PRESIDENT, CFO, SECRETARY

3. Statement for Issuer's Fiscal Year Ended (Month/Day/Year)
12/31/2011

4. If Amendment, Date of Original Filed (Month/Day/Year)

6. Individual or Joint/Group Filing (Check Applicable Line)

X	Form filed by One Reporting Person
	Form filed by More than One Reporting Person

Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
1. Title of Security (Instr. 3)	2. Transaction Date (Month/Day/Year)	2A. Deemed Execution Date, if any (Month/Day/Year)	3. Transaction Code (Instr. 8)	4. Securities Acquired (A) or Disposed Of (D) (Instr. 3, 4 and 5)			5. Amount of Securities Beneficially Owned at end of Issuer's Fiscal Year (Instr. 3 and 4)	6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)	7. Nature of Indirect Beneficial Ownership (Instr. 4)
1. Title of Security (Instr. 3)	2. Transaction Date (Month/Day/Year)	2A. Deemed Execution Date, if any (Month/Day/Year)	3. Transaction Code (Instr. 8)	Amount	(A) or (D)	Price		6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)	7. Nature of Indirect Beneficial Ownership (Instr. 4)
Common Stock							12,800,000	I	Held by JTR Investments, Limited
Common Stock							400,000	I	Held by The Ross Family Trust u/t/a Dated December 1999
Common Stock							8,000	I	Held by spouse
Common Stock							335,880	I	Held by Afritex Medical Products (Pty) Ltd.

Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 3)	2. Conversion or Exercise Price of Derivative Security	3. Transaction Date (Month/Day/Year)	3A. Deemed Execution Date, if any (Month/Day/Year)	4. Transaction Code (Instr. 8)	5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5)		6. Date Exercisable and Expiration Date (Month/Day/Year)		7. Title and Amount of Securities Underlying Derivative Security (Instr. 3 and 4)		8. Price of Derivative Security (Instr. 5)	9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4)	10. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)	11. Nature of Indirect Beneficial Ownership (Instr. 4)
1. Title of Derivative Security (Instr. 3)	2. Conversion or Exercise Price of Derivative Security	3. Transaction Date (Month/Day/Year)	3A. Deemed Execution Date, if any (Month/Day/Year)	4. Transaction Code (Instr. 8)	(A)	(D)	Date Exercisable	Expiration Date	Title	Amount or Number of Shares	8. Price of Derivative Security (Instr. 5)		10. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)	11. Nature of Indirect Beneficial Ownership (Instr. 4)
Warrants	$0.01						12/31/2008	12/31/2013	Common Shares	116,667		116,667	I	Held by JTR Investments, Limited
Warrants	$0.01						12/31/2008	12/31/2013	Common Shares	163,818		163,818	I	Held by JTR Investments, Limited
Warrants	$0.01						06/30/2009	06/30/2014	Common Shares	48,358		48,358	I	Held by JTR Investments, Limited
Warrants	$0.01						12/31/2009	12/31/2014	Common Shares	52,640		52,640	I	Held by JTR Investments, Limited
Warrants	$0.01						03/31/2011	03/31/2016	Common Shares	42,872		42,872	I	Held by JTR Investments, Limited
Warrants	$0.01						06/30/2011	06/30/2016	Common Shares	107,811		107,811	I	Held by JTR Investments, Limited
Warrants	$2.5						03/26/2010	03/26/2016	Common Shares	270,000		270,000	I	Held by Afritex Medical Products (Pty) Ltd.
Warrants	$0.01	09/30/2011⁽¹⁾		4A	35,006		09/30/2011	09/30/2016	Common Shares	35,006	$0	35,006	I	Held by JTR Investments, Limited
Warrants	$0.01	12/31/2011⁽¹⁾		4A	21,000		12/31/2011	12/31/2016	Common Shares	21,000	$0	21,000	I	Held by JTR Investments, Limited
Options (Right to buy)	$0.25						01/15/2005	01/15/2015	Common Shares	108,962		108,962	D
Options (Right to buy)	$0.25						01/15/2006	01/15/2016	Common Shares	180,000		180,000	D
Options (Right to buy)	$0.25						01/15/2007	01/15/2017	Common Shares	180,000		180,000	D
Options (Right to buy)	$0.25						01/15/2008	01/15/2018	Common Shares	180,000		180,000	D
Options (Right to buy)	$0.25						01/15/2009	01/15/2019	Common Shares	180,000		180,000	D
Options (Right to buy)	$0.25						01/15/2010	01/15/2020	Common Shares	180,000		180,000	D
Options (Right to buy)	$0.25						01/15/2011	01/15/2021	Common Shares	180,000		180,000	D
Options (Right to buy)	$0.25	01/15/2011⁽²⁾		4A	30,000⁽²⁾		10/15/2011	10/15/2021	Common Shares	165,000	$0	165,000	D
Options (Right to buy)	$0.72						03/01/2005	03/01/2015	Common Shares	16,500		16,500	I	Held by spouse
Options (Right to buy)	$0.72						03/01/2006	03/01/2016	Common Shares	20,000		20,000	I	Held by spouse
Options (Right to buy)	$0.72						03/01/2007	03/01/2017	Common Shares	12,500		12,500	I	Held by spouse
Options (Right to buy)	$0.72						03/01/2008	03/01/2018	Common Shares	7,500		7,500	I	Held by spouse
Options (Right to buy)	$0.72						03/01/2009	03/01/2019	Common Shares	5,000		5,000	I	Held by spouse
Options (Right to buy)	$1						03/01/2010	03/01/2015	Common Shares	10,000		10,000	I	Held by spouse
Options (Right to buy)	$1						03/01/2011	03/01/2016	Common Shares	10,000		10,000	I	Held by spouse
Warrants	$0.01						09/30/2008	09/30/2013	Common Shares	7,000		7,000	I	Held by spouse
Convertible Securities	$1.5						03/01/2008	04/15/2013⁽³⁾	Common Shares	166,667		166,667	I	Held by JTR Investments, Limited
Convertible Securities	$1.5						12/31/2008	⁽⁴⁾	Common Shares	220,700		220,700	I	Held by JTR Investments, Limited.
Convertible Securities	$1.5						06/30/2009	⁽⁴⁾	Common Shares	77,233		77,233	I	Held by JTR Investments, Limited
Convertible Securities	$1.5						12/31/2009	⁽⁴⁾	Common Shares	61,200		61,200	I	Held by JTR Investments, Limited
Convertible Securities	$1.5						03/31/2010	⁽⁴⁾	Common Shares	30,000		30,000	I	Held by JTR Investments, Limited

Explanation of Responses:

1. Acquired in routine quarterly acquisitions pursuant to the terms of that certain JTR Senior Note dated November 1, 2008 (as modified on March 30, 2011).

2. Automatic vesting of stock options previously issued. 15,000 options vested on 11/15/2011 and 15,000 options vested on 12/15/2011.

3. Modified maturity date of this subordinated convertible promissory note, per that certain modification dated November 14, 2011.

4. Demand notes.

	/s/ Julian T. Ross	02/10/2012
	** Signature of Reporting Person	Date
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
* If the form is filed by more than one reporting person, see Instruction 4 (b)(v).
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