SEC Form 4 · accession 0000899243-16-036392
Fuse Medical, Inc. · FZMD
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 owners
NC 143 Family Holdings, LP
10% Owner
Mark W Brooks
Officer — See Remarks · Director · 10% Owner
Period of report
Dec 19, 2016
Accepted (ET)
Dec 29, 2016 · 3:54 pm EST
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0000319016
Table I — non-derivative securities
| Security | Date | Code | Shares | Price | A/D | Owned after | D/I | Nature of ownership |
|---|---|---|---|---|---|---|---|---|
| Common StockF1 | Dec 19, 2016 | P | 5,000,000 | $0.08 | A | 5,000,000 | I | See Footnote |
Table II — derivative securities
No Table II lines on this filing.
Explanation of responses
- F1These securities are directly owned by NC 143 Family Holdings, LP, a Texas limited partnership ("NC 143"). Mark W. Brooks is the sole trustee of Medtech Family Trust dated October 1, 2014 ("Medtech"), the sole manager of NC 143 Family Holdings GP LLC (the "GP"), the sole general partner of NC 143. Accordingly, each of Mark W. Brooks, Medtech and the GP indirectly beneficially owns the reported securities.
Remarks
Chairman of the Board of Directors