Sec Form 5/A Filing - LINARES RONALD T @ OMNICOMM SYSTEMS INC - 2012-12-31

Insider filing report for Changes in Beneficial Ownership
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FORM 5/A
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP
Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(h) of the Investment Company Act of 1940
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1. Name and Address of Reporting Person
LINARES RONALD T
2. Issuer Name and Ticker or Trading Symbol
OMNICOMM SYSTEMS INC [ OMCM]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
_____ Director _____ 10% Owner
_____ Officer (give title below) X __ Other (specify below)
Former CFO
(Last) (First) (Middle)
2101 W. COMMERCIAL BLVD., SUITE 3500
3. Date of Earliest Transaction (MM/DD/YY)
12/31/2012
(Street)
FORT LAUDERDALE, FL33309
4. If Amendment, Date Original Filed (MM/DD/YY)
02/04/2013
6. Individual or Joint/Group Filing (Check Applicable Line)
__ X __ Form filed by One Reporting Person
_____ Form filed by More than One Reporting Person
(City) (State) (Zip)
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
1.Title of Security
(Instr. 3)
2. Transaction Date (MM/DD/YY) 2A. Deemed Execution Date, if any (MM/DD/YY) 3. Transaction Code
(Instr. 8)
4. Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
5. Amount of Securities Beneficially Owned Following Reported Transaction(s)
(Instr. 3 and 4)
6. Ownership Form: Direct (D) or Indirect (I)
(Instr. 4)
7. Nature of Indirect Beneficial Ownership
(Instr. 4)
Code V Amount (A) or (D) Price
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 (MM/DD/YY) 3A. Deemed Execution Date, if any (MM/DD/YY) 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
(MM/DD/YY)
7. Title and Amount of Underlying Securities
(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 of Derivative Security: Direct (D) or Indirect (I)
(Instr. 4)
11. Nature of Indirect Beneficial Ownership
(Instr. 4)
Code V (A) (D) Date Exercisable Expiration Date Title Amount or Number of Shares
Convertible Debenture $ 0.5 01/01/2012 J( 1 ) V 250,000 12/16/2008( 1 ) 12/16/2013 Common Stock 250,000 $ 0.5 0 D
Common Stock Warrant $ 0.5 01/01/2012 J( 1 ) V 250,000 12/16/2008( 1 ) 12/16/2013 Common Stock 250,000 $ 0.5 0 D
Reporting Owners
Reporting Owner Name / Address Relationships
Director 10% Owner Officer Other
LINARES RONALD T
2101 W. COMMERCIAL BLVD.
SUITE 3500
FORT LAUDERDALE, FL33309
Former CFO
Signatures
/s/ Ronald T. Linares 03/25/2013
Signature of Reporting Person Date
Explanation of Responses:
( 1 )On January 1, 2012, the Reporting Person assigned a Convertible Note of the Issuer dated December 16, 2008 in the amount of $125,000 convertible into 250,000 shares of common stock of the Issuer and warrants convertible into 250,000 shares of common stock of the Issuer at an exercise price of $0.50 with an expiration date of December 16, 2013 to Cornelis F. Wit, CEO and Director of the Issuer. As part of the assignment from Mr. Linares to Mr. Wit, a personal promissory note from Mr. Linares to Mr. Wit in the amount of $100,000 was deemed fully satisfied. In addition, the transaction was part of a business relationship with Mr. Wit involving numerous other transactions unrelated to the Issuer and the Issuer's securities which in the aggregate the Reporting Person is not able to quantify the consideration paid for the securities.

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