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.
X
Form 4 Transactions Reported.
1. Name and Address of Reporting Person*
Ross Julian T

(Last) (First) (Middle)
10880 JOHN W. ELLIOTT DRIVE,
SUITE 600

(Street)
FRISCO TX 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, Secretary
3. Statement for Issuer's Fiscal Year Ended (Month/Day/Year)
12/31/2013
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)
Amount (A) or (D) Price
Common Stock 14,025,761 I Held by JTR Investments, Limited
Common Stock 400,000 I Held by The Ross Family Trust
Common Stock 371,474 D
Common Stock 12/13/2013(1) L4 2,100 A $0.7729(2) 373,574 D
Common Stock 02/12/2014(3) L4 6,300 A $0.6508(4) 379,874 D
Common Stock 116,182 I Held by Spouse
Common Stock 02/12/2014 G4 100,000 D(5) $0 14,025,761 I Held by JTR Investments, Limited
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)
(A) (D) Date Exercisable Expiration Date Title Amount or Number of Shares
Options (right to buy) $0.25 01/15/2005(8) 12/15/2022(9) Common Stock 1,177,488 1,177,488(6) D
Options (right to buy) $0.25 06/05/2013(7) 4A 120,000 07/05/2013(8) 02/05/2024(9) Common Stock 120,000(7) $0(7) 1,297,488(7) D
Options (right to buy) $0.72 03/01/2005(8) 03/01/2019(9) Common Stock 101,500 101,500 I Held by Spouse
Warrants $0.01 09/30/2008 09/30/2013 Common Stock 7,000 7,000 I Held by Spouse
Explanation of Responses:
1. Small acquisitions (open market purchases) under Rule 16a-6 during the period June 20, 2013 through December 13, 2013.
2. Per share acquisition prices ranging from $.6999 to $.8299, with an aggregate per share price for all the transactions of $.7729.
3. Small acquisitions (open market purchases) under Rule 16a-6 during the period January 1, 2014 through February 12, 2014.
4. Per share acquisition prices ranging from $.6099 to $.7487, with an aggregate per share price for all the transactions of $.6508.
5. Bona fide gift to Tim Hutton, the spouse of Vicki Jones, who is a Director of the Company.
6. Comprises vested options issued pursuant to various employment agreements prior to January 15, 2013 under the Company's 2004 Stock Option Plan.
7. Comprises vested options as at February 14, 2014; options are issued pursuant to that certain employment agreement renewal dated June 5, 2013, under the Company's 2004 Stock Option Plan.
8. Represents the earliest date(s) that any options became exercisable.
9. Represents the latest date(s) that any vested options expire.
/s/ Julian T Ross 02/14/2014
** 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).
** Intentional misstatements or omissions of facts constitute Federal Criminal Violations See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure.
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number.