SEC Form 4 · accession 0000899243-17-001246
Fuse Medical, Inc. · FZMD
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Period of report
Dec 19, 2016
Accepted (ET)
Jan 13, 2017 · 2:56 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"); Medtech is the sole manager of NC 143 Family Holdings GP LLC (the "GP"); and 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. This Form 4 is filed by Medtech and the GP. NC 143 and Mark W. Brooks previously jointly filed a Form 4 reporting the acquisition of these securities.