0000899243-17-029304.txt : 20171220 0000899243-17-029304.hdr.sgml : 20171220 20171220154955 ACCESSION NUMBER: 0000899243-17-029304 CONFORMED SUBMISSION TYPE: 4/A PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20170921 FILED AS OF DATE: 20171220 DATE AS OF CHANGE: 20171220 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Bosita Renato V. Jr. CENTRAL INDEX KEY: 0001718877 FILING VALUES: FORM TYPE: 4/A SEC ACT: 1934 Act SEC FILE NUMBER: 000-10093 FILM NUMBER: 171266753 MAIL ADDRESS: STREET 1: TEXAS BACK INSTITUTE STREET 2: 6020 WEST PARKER ROAD #200 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/A 1 doc4a.xml FORM 4/A SUBMISSION X0306 4/A 2017-09-21 2017-10-10 0 0000319016 Fuse Medical, Inc. FZMD 0001718877 Bosita Renato V. Jr. 6020 WEST PARKER ROAD # 200 PLANO TX 75093 1 0 0 0 Common Stock 2017-09-21 4 A 0 65000 0.20 A 65000 D Common Stock 2017-09-21 4 A 0 1000000 0.20 A 1065000 D This Form 4/A amends the price of the Issuer's common stock, par value $0.01 ("Common Stock"), on the original Form 4 filed on 10/10/2017. In consultation with a valuation firm, the Issuer's board of directors determined that at the time of the Reporting Person's acquisition, the Common Stock's fair market value was $0.20 per share. In consultation with a valuation firm, the Issuer's board of directors determined that at the time of the Reporting Person's acquisition, the Common Stock's fair market value was $0.20 per share. /s/ Renato V. Bosita Jr. 2017-12-19