SEC Form 4 · accession 0001477932-16-014048
Fuse Medical, Inc. · FZMD
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Chris Pratt
Officer — Chief Executive Officer · Director · 10% Owner
Period of report
Dec 10, 2016
Accepted (ET)
Dec 13, 2016 · 4:52 pm EST
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0000319016
Table I — non-derivative securities
No Table I lines on this filing.
Table II — derivative securities
| Security | Conv. / exercise price | Date | Code | Shares | A/D | Exercisable | Expires | Underlying | Underlying shares | Owned after | D/I |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Stock Options (Right to Buy)F1,F2 | $0.11 | Dec 10, 2016 | A | 300,000 | A | Dec 10, 2016 | Dec 10, 2021 | Common Stock | 300,000 | 300,000 | D |
Explanation of responses
- F1Fully vested options.
- F2Not applicable.