0001104659-23-128871.txt : 20231222 0001104659-23-128871.hdr.sgml : 20231222 20231222170131 ACCESSION NUMBER: 0001104659-23-128871 CONFORMED SUBMISSION TYPE: F-X PUBLIC DOCUMENT COUNT: 1 FILED AS OF DATE: 20231222 DATE AS OF CHANGE: 20231222 EFFECTIVENESS DATE: 20231222 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: Quipt Home Medical Corp. CENTRAL INDEX KEY: 0001540013 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-MISC HEALTH & ALLIED SERVICES, NEC [8090] ORGANIZATION NAME: 08 Industrial Applications and Services IRS NUMBER: 000000000 STATE OF INCORPORATION: A1 FISCAL YEAR END: 0930 FILING VALUES: FORM TYPE: F-X SEC ACT: 1933 Act SEC FILE NUMBER: 333-276253 FILM NUMBER: 231510643 BUSINESS ADDRESS: STREET 1: 1019 TOWN DRIVE CITY: WILDER STATE: KY ZIP: 41076 BUSINESS PHONE: 859-878-2220 MAIL ADDRESS: STREET 1: 1019 TOWN DRIVE CITY: WILDER STATE: KY ZIP: 41076 FORMER COMPANY: FORMER CONFORMED NAME: Protech Home Medical Corp. DATE OF NAME CHANGE: 20200714 FORMER COMPANY: FORMER CONFORMED NAME: Patient Home Monitoring Corp. DATE OF NAME CHANGE: 20120119 FILED BY: COMPANY DATA: COMPANY CONFORMED NAME: Quipt Home Medical Corp. CENTRAL INDEX KEY: 0001540013 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-MISC HEALTH & ALLIED SERVICES, NEC [8090] ORGANIZATION NAME: 08 Industrial Applications and Services IRS NUMBER: 000000000 STATE OF INCORPORATION: A1 FISCAL YEAR END: 0930 FILING VALUES: FORM TYPE: F-X BUSINESS ADDRESS: STREET 1: 1019 TOWN DRIVE CITY: WILDER STATE: KY ZIP: 41076 BUSINESS PHONE: 859-878-2220 MAIL ADDRESS: STREET 1: 1019 TOWN DRIVE CITY: WILDER STATE: KY ZIP: 41076 FORMER COMPANY: FORMER CONFORMED NAME: Protech Home Medical Corp. DATE OF NAME CHANGE: 20200714 FORMER COMPANY: FORMER CONFORMED NAME: Patient Home Monitoring Corp. DATE OF NAME CHANGE: 20120119 F-X 1 tm2333569d2_fx.htm FORM F-X

 

UNITED STATES
SECURITIES AND EXCHANGE COMMISSION

Washington, D.C. 20549

 

FORM F-X

 

APPOINTMENT OF AGENT FOR SERVICE OF PROCESS AND UNDERTAKING

 

A. Name of issuer or person filing (“Filer”): Quipt Home Medical Corp.
     
B. (1) This is an (check one):  
  x original filing for the Filer  
  ¨ amended filing for the Filer  
  (2) Check the following box if you are filing the Form F-X in paper in accordance with Regulation S-T Rule 101(b)(9) ¨
     
C. Identify the filing in conjunction with which this form is being filed:
   
  Name of Registrant: Quipt Home Medical Corp.
  Form type: Registration Statement on Form F-10
  File Number (if known): 333-276253
  Filed by: Quipt Home Medical Corp.
  Date Filed (if filed concurrently, so indicate): December 22, 2023 (filed concurrently)
     
D. The Filer is incorporated or organized under the laws of the Province of British Columbia, Canada and has its principal place of business at 1019 Town Drive, Wilder, Kentucky 41076 and telephone number (859) 878-2220.
   
E. The Filer designates and appoints C T Corporation System (“Agent”), located at 1015 15th Street N.W., Suite 1000, Washington, DC 20005; telephone (202) 572-3100 as the agent of the Filer upon whom may be served any process, pleadings, subpoenas, or other papers in:
   
  (a) any investigation or administrative proceeding conducted by the U.S. Securities and Exchange Commission (the “Commission”); and
  (b) any civil suit or action brought against the Filer or to which the Filer has been joined as defendant or respondent, in any appropriate court in any place subject to the jurisdiction of any state or of the United States or of any of its territories or possessions or of the District of Columbia, where the investigation, proceeding or cause of action arises out of or relates to or concerns: (i) any offering made or purported to be made in connection with the securities registered or qualified by the Filer on Form F-10 on the date hereof or any purchases or sales of any security in connection therewith; (ii) the securities in relation to which the obligation to file an annual report on Form 40-F arises, or any purchases or sales of such securities; (iii) any tender offer for the securities of a Canadian issuer with respect to which filings are made by the Filer with the Commission on Schedule 13E-4F, 14D-1F or 14D-9F; or (iv) the securities in relation to which the Filer acts as trustee pursuant to Rule 10a-5 under the Trust Indenture Act of 1939. The Filer stipulates and agrees that any such civil suit or action or administrative proceeding may be commenced by the service of process upon, and that service of an administrative subpoena shall be effected by service upon such agent for service of process, and that service as aforesaid shall be taken and held in all courts and administrative tribunals to be valid and binding as if personal service thereof had been made.
     
F.   The Filer stipulates and agrees to appoint a successor agent for service of process and file an amended Form F-X if the Filer discharges the Agent or the Agent is unwilling or unable to accept service on behalf of the Filer at any time until six years have elapsed from the date the Filer has ceased reporting under the Securities Exchange Act of 1934, as amended. The Filer further undertakes to advise the Commission promptly of any change to the Agent’s name or address during the applicable period by amendment of this Form F-X, referencing the file number of the relevant form in conjunction with which the amendment is being filed.
     
G.   The Filer undertakes to make available, in person or by telephone, representatives to respond to inquiries made by the Commission staff, and to furnish promptly, when requested to do so by the Commission staff, information relating to the forms, schedules, and offering statements described in General Instructions I.(a), I.(b), I.(c), I.(d) and I.(f) of this Form, as applicable; the securities to which such forms, schedules and offering statements relate; and the transaction in such securities.

 

 

 

 

The Filer certifies that it has duly caused this power of attorney, consent, stipulation and agreement to be signed on its behalf by the undersigned, thereunto duly authorized, in the City of Wilder, Kentucky, Country of the United States this 22nd day of December, 2023.

 

Filer: QUIPT HOME MEDICAL CORP.
   
  By: /s/ Gregory Crawford
    Name: Gregory Crawford
    Title: Chief Executive Officer

 

 

 

 

This statement has been signed by the following person in the capacity and on the date indicated:

 

  C T CORPORATION SYSTEM
  (Agent for Service)
   
  By: /s/ Devin Randolph
    Name:  Devin Randolph
    Title: Assistant Secretary
   
  Dated: December 22, 2023