SEC Form 4
FORM 4 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP

Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934
or Section 30(h) of the Investment Company Act of 1940
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Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
1. Name and Address of Reporting Person*
Reeg Christopher C

(Last) (First) (Middle)
3024 WESTMINSTER AVENUE

(Street)
DALLAS TX 75205

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
Fuse Medical, Inc. [ FZMD ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director X 10% Owner
X Officer (give title below) Other (specify below)
Chief Executive Officer
3. Date of Earliest Transaction (Month/Day/Year)
08/01/2018
4. If Amendment, Date of Original Filed (Month/Day/Year)
08/03/2018
6. Individual or Joint/Group Filing (Check Applicable Line)
X Form filed by One Reporting Person
Form filed by More than One Reporting Person
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
1. Title of Security (Instr. 3) 2. Transaction Date (Month/Day/Year) 2A. Deemed Execution Date, if any (Month/Day/Year) 3. Transaction Code (Instr. 8) 4. Securities Acquired (A) or Disposed Of (D) (Instr. 3, 4 and 5) 5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4) 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 7. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V Amount (A) or (D) Price
Common Stock 08/01/2018 P 2,539,474(1)(2) A $0.76 6,539,474 I By Reeg Medical Industries, Inc.(4)
Common Stock 10/04/2018 P 72,139(3) A $0.68 6,611,613 I By Reeg Medical Industries, Inc.(4)
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 3) 2. Conversion or Exercise Price of Derivative Security 3. Transaction Date (Month/Day/Year) 3A. Deemed Execution Date, if any (Month/Day/Year) 4. Transaction Code (Instr. 8) 5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) 6. Date Exercisable and Expiration Date (Month/Day/Year) 7. Title and Amount of Securities Underlying Derivative Security (Instr. 3 and 4) 8. Price of Derivative Security (Instr. 5) 9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) 10. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 11. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V (A) (D) Date Exercisable Expiration Date Title Amount or Number of Shares
Explanation of Responses:
1. This Form 4/A amends the Form 4 filed by Christopher C. Reeg ("Reeg") on August 3, 2018, to correct the number of shares of common stock, par value $0.01 (the "Common Stock"), of the Fuse Medical, Inc., a Delaware corporation (the "Company"), that Reeg received pursuant to that certain Securities Purchase Agreement, dated July 30, 2018 (the "Maxim Purchase Agreement"), by and between the Company, Palm Springs Partners, LLC d/b/a Maxim Surgical, a Texas limited liability company ("Maxim"), Reeg Medical Industries, Inc., a Texas corporation ("RMI"), Mr. Amir David Tahernia, an individual ("Tahernia", together with RMI, the "Sellers"), and Tahernia in his capacity as the representative of the Sellers (the "Sellers Representative").
2. (Continued from Footnote 1) The Company made a calculation error when computing the number of shares of Common Stock issued to RMI, and corrected the number in its Current Report on Form 8-K/A filed with the Securities and Exchange Commission (the "SEC") on November 16, 2018 (the "Maxim Form 8-K/A").
3. On October 4, 2018, the Company issued 72,139 shares of Common Stock to RMI, which represents RMI's pro rata share of the agreed-upon purchase price adjustment pursuant to Pursuant to the Maxim Purchase Agreement, as reported in the Maxim Form 8-K/A.
4. These securities are directly owned by RMI. Reeg is the sole shareholder, sole director, and sole officer of RMI. Accordingly, Reeg indirectly beneficially owns the reported securities.
Remarks:
/s/ Christopher C. Reeg 11/27/2018
** Signature of Reporting Person Date
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
* If the form is filed by more than one reporting person, see Instruction 4 (b)(v).
** Intentional misstatements or omissions of facts constitute Federal Criminal Violations See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
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