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