0000899243-17-001246.txt : 20170113 0000899243-17-001246.hdr.sgml : 20170113 20170113145649 ACCESSION NUMBER: 0000899243-17-001246 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20161219 FILED AS OF DATE: 20170113 DATE AS OF CHANGE: 20170113 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Fuse Medical, Inc. CENTRAL INDEX KEY: 0000319016 STANDARD INDUSTRIAL CLASSIFICATION: WHOLESALE-MEDICAL, DENTAL & HOSPITAL EQUIPMENT & SUPPLIES [5047] IRS NUMBER: 591224913 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 1300 SUMMIT AVE STREET 2: SUITE 670 CITY: FORT WORTH STATE: TX ZIP: 76102 BUSINESS PHONE: 817-439-7025 MAIL ADDRESS: STREET 1: 1300 SUMMIT AVE STREET 2: SUITE 670 CITY: FORT WORTH STATE: TX ZIP: 76102 FORMER COMPANY: FORMER CONFORMED NAME: GOLF ROUNDS COM INC DATE OF NAME CHANGE: 19991126 FORMER COMPANY: FORMER CONFORMED NAME: AMERICAN METALS SERVICE INC DATE OF NAME CHANGE: 19920703 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: NC 143 Family Holdings GP LLC CENTRAL INDEX KEY: 0001693757 STATE OF INCORPORATION: TX FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-10093 FILM NUMBER: 17527573 BUSINESS ADDRESS: STREET 1: 1565 NORTH CENTRAL EXPRESSWAY, SUITE 200 CITY: RICHARDSON STATE: TX ZIP: 75080 BUSINESS PHONE: 2142899914 MAIL ADDRESS: STREET 1: 1565 NORTH CENTRAL EXPRESSWAY, SUITE 200 CITY: RICHARDSON STATE: TX ZIP: 75080 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Medtech Family Trust CENTRAL INDEX KEY: 0001693760 STATE OF INCORPORATION: TX FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-10093 FILM NUMBER: 17527574 BUSINESS ADDRESS: STREET 1: 1565 NORTH CENTRAL EXPRESSWAY, SUITE 200 CITY: RICHARDSON STATE: TX ZIP: 75080 BUSINESS PHONE: 2142899914 MAIL ADDRESS: STREET 1: 1565 NORTH CENTRAL EXPRESSWAY, SUITE 200 CITY: RICHARDSON STATE: TX ZIP: 75080 4 1 doc4.xml FORM 4 SUBMISSION X0306 4 2016-12-19 0 0000319016 Fuse Medical, Inc. FZMD 0001693760 Medtech Family Trust 1565 NORTH CENTRAL EXPWY, SUITE 200 RICHARDSON TX 75080 0 0 1 0 0001693757 NC 143 Family Holdings GP LLC 1565 NORTH CENTRAL EXPWY, SUITE 200 RICHARDSON TX 75080 0 0 1 0 Common Stock 2016-12-19 4 P 0 5000000 0.08 A 5000000 I See Footnote These 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. /s/ Mark W. Brooks, Trustee of Medtech Family Trust, sole manager of NC 143 Family Holdings GP LLC 2017-01-13