SEC Form 4 · accession 0000899243-17-023957
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 owner
Renato V. Bosita Jr.
Director
Period of report
Sep 21, 2017
Accepted (ET)
Oct 10, 2017 · 4:45 pm EDT
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 | Sep 21, 2017 | A | 65,000 | $0.78 | A | 65,000 | D | |
| Common StockF2 | Sep 21, 2017 | A | 1,000,000 | $0.78 | A | 1,065,000 | D |
Table II — derivative securities
No Table II lines on this filing.
Explanation of responses
- F1On September 21, 2017, the Reporting Person was granted 65,000 shares of the Issuer's restricted common stock, pursuant to the 2017 Equity Incentive Plan of Fuse Medical, Inc. (incorporated by reference to Exhibit 99.2 to the Issuer's Form 8-K filed on April 6, 2017 (File No. 000-10093)), which will vest and cease to be subject to forfeiture (i) on the September 21, 2018, or (ii) in accordance with the vesting provisions of the Restricted Stock Award Agreement (incorporated by reference to Exhibit 10.1 to the Issuer's Form 8-K filed on October 10, 2017 (File No. 000-10093)).
- F2On September 21, 2017, the Reporting Person was granted 1,000,000 shares of the Issuer's restricted common stock, pursuant to the 2017 Equity Incentive Plan of Fuse Medical, Inc. (incorporated by reference to Exhibit 99.2 to the Issuer's Form 8-K filed on April 6, 2017 (File No. 000-10093)), which will vest and cease to be subject to forfeiture in accordance with the vesting provisions of the Restricted Stock Award Agreement (incorporated by reference to Exhibit 10.2 to the Issuer's Form 8-K filed on October 10, 2017 (File No. 000-10093)).