SEC Form 4 · accession 0001437749-18-022661
OMNICOMM SYSTEMS INC · OMCM
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
A later amendment supersedes this filing — read the amendment. The figures below are kept as originally reported (version chain, not an overwrite).
Reporting owner
Cornelis F Wit
Officer — Executive Chairman · Director · 10% Owner
Period of report
Dec 27, 2018
Accepted (ET)
Dec 27, 2018 · 5:02 pm EST
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0001034592
Table I — non-derivative securities
| Security | Date | Code | Shares | Price | A/D | Owned after | D/I | Nature of ownership |
|---|---|---|---|---|---|---|---|---|
| Common StockF1 | Dec 27, 2018 | M | 2,000,000 | $0.25 | A | 51,908,050 | I | Trust |
| Common Stock | holding | — | — | — | 200,000 | D |
Table II — derivative securities
| Security | Conv. / exercise price | Date | Code | Shares | A/D | Exercisable | Expires | Underlying | Underlying shares | Owned after | D/I |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Common Stock Warrant | $0.25 | Dec 27, 2018 | P | 2,000,000 | A | Dec 27, 2018 | Jan 1, 2019 | Common Stock | 2,000,000 | 2,000,000 | D |
| Common Stock Warrant | $0.25 | Dec 27, 2018 | M | 2,000,000 | D | Dec 27, 2018 | Jan 1, 2019 | Common Stock | 2,000,000 | 0 | D |
Explanation of responses
- F1On December 27, 2018, OmniCOmm Systems Inc. (the "Company") issued 2,000,000 shares of common stock to Mr. WIt upon the cash exercise of Warrants at an exercise price of $0.25.