0000899243-17-023962.txt : 20171010 0000899243-17-023962.hdr.sgml : 20171009 20171010164906 ACCESSION NUMBER: 0000899243-17-023962 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20170921 FILED AS OF DATE: 20171010 DATE AS OF CHANGE: 20171010 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Kalra Ricky Raj S. CENTRAL INDEX KEY: 0001718878 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-10093 FILM NUMBER: 171130976 MAIL ADDRESS: STREET 1: 2513 SUNTREE LANE CITY: PLANO STATE: TX ZIP: 75025 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: 1565 NORTH CENTRAL EXPRESSWAY STREET 2: SUITE 220 CITY: RICHARDSON STATE: TX ZIP: 75080 BUSINESS PHONE: 469-862-3030 MAIL ADDRESS: STREET 1: 1565 NORTH CENTRAL EXPRESSWAY STREET 2: SUITE 220 CITY: RICHARDSON STATE: TX ZIP: 75080 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 4 1 doc4.xml FORM 4 SUBMISSION X0306 4 2017-09-21 0 0000319016 Fuse Medical, Inc. FZMD 0001718878 Kalra Ricky Raj S. 5425 W SPRING CREEK PKWY SUITE 133 PLANO TX 75025 1 0 0 0 Common Stock 2017-09-21 4 A 0 65000 0.78 A 65000 D Common Stock 2017-09-21 4 A 0 1000000 0.78 A 1065000 D On 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)). On 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)). /s/ Ricky Raj S. Kalra, M.D. 2017-10-10