0000899243-18-031013.txt : 20181214 0000899243-18-031013.hdr.sgml : 20181214 20181214115026 ACCESSION NUMBER: 0000899243-18-031013 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20181213 FILED AS OF DATE: 20181214 DATE AS OF CHANGE: 20181214 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: 181234959 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 2018-12-13 0 0000319016 Fuse Medical, Inc. FZMD 0001718878 Kalra Ricky Raj S. 2513 SUNTREE LANE PLANO TX 75025 1 0 0 0 Common Stock 2018-12-13 4 A 0 222223 0.45 A 1475723 D On December 13, 2018 the Reporting Person was granted 222,223 shares (the "Shares") of the restricted common stock, par value $0.01 per share (the "Common Stock"), of Fuse Medical, Inc. (the "Company") pursuant to the 2017 Equity Incentive Plan of Fuse Medical, Inc. (the "2017 Plan") (incorporated by reference to Exhibit 99.2 of the Issuer's Form 8-K filed with the Securities and Exchange Commisssion (the "SEC") on April 6, 2017 (File No. 000-100093)), subject to the terms and conditions in the 2017 Plan and the form of Restricted Stock Award Agreement (incorporated by reference to Exhibit 10.2 to the Issuer's Form 8-K filed with the SEC on October 10, 2017 (File NO. 000-100093)). (Continued From Footnote 1) The Shares will vest and cease to be subject to forfeiture upon (a) the occurrence of one of the following events (each, an "Accelerating Event"): (i) a Change in Control (as defined in the 2017 Plan), (ii) the Reporting Person's Termination of Continuous Service (as defined in the 2017 Plan), or (iii) the listing of the Common Stock on either the New York Stock Exchange or the NASDAQ Stock Market; and (b) the delivery by the Reporting Person to the Company of a Notice of Acceleration of Vesting, no later than sixty (60) days following the earlier of (i) the date the Company sends written notice of such Accelerating Event or (ii) the date the Reporting Person actually or constructively becomes aware that such Accelerating Event has occurred. /s/ Ricky Raj S. Kalra, MD 2018-12-13