SEC Form 4/A · accession 0001437749-19-000321
OMNICOMM SYSTEMS INC · OMCM
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
This is an amendment (Form 4/A). It replaces an earlier filing for the same period.
Reporting owner
Keith L Howells
Officer — Chief Technology Officer
Period of report
Dec 27, 2018
Accepted (ET)
Jan 4, 2019 · 2:35 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 | O | 1,000,000 | $0.25 | A | 2,361,000 | 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 | O | 1,000,000 | D | Nov 23, 2015 | Jan 1, 2019 | Common Stock | 1,000,000 | 0 | D |
Explanation of responses
- F1On December 27, 2018, OmniComm Systems Inc. (the "Company") issued 1,000,000 shares of common stock to Mr. Howells upon the cash exercise of Warrants at an exercise price of $0.25.
- F2The original Form 4, filed on December 27, 2018, is being amended by this Form 4 amendment solely to correct an administrative error relating to the transaction codes reported in Box 3 of Table I and Box 4 of Table II. This corrected Form 4 reflects the correct transaction codes of O.