0000899243-18-003256.txt : 20180208
0000899243-18-003256.hdr.sgml : 20180208
20180208145806
ACCESSION NUMBER: 0000899243-18-003256
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20171229
FILED AS OF DATE: 20180208
DATE AS OF CHANGE: 20180208
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Medtech Family Trust
CENTRAL INDEX KEY: 0001693760
STATE OF INCORPORATION: TX
FISCAL YEAR END: 1231
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 000-10093
FILM NUMBER: 18585265
BUSINESS ADDRESS:
STREET 1: 1565 NORTH CENTRAL EXPRESSWAY, SUITE 200
CITY: RICHARDSON
STATE: TX
ZIP: 75080
BUSINESS PHONE: 2142899914
MAIL ADDRESS:
STREET 1: 1565 NORTH CENTRAL EXPRESSWAY, SUITE 200
CITY: RICHARDSON
STATE: TX
ZIP: 75080
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: NC 143 Family Holdings GP LLC
CENTRAL INDEX KEY: 0001693757
STATE OF INCORPORATION: TX
FISCAL YEAR END: 1231
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 000-10093
FILM NUMBER: 18585264
BUSINESS ADDRESS:
STREET 1: 1565 NORTH CENTRAL EXPRESSWAY, SUITE 200
CITY: RICHARDSON
STATE: TX
ZIP: 75080
BUSINESS PHONE: 2142899914
MAIL ADDRESS:
STREET 1: 1565 NORTH CENTRAL EXPRESSWAY, SUITE 200
CITY: RICHARDSON
STATE: TX
ZIP: 75080
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: NC 143 Family Holdings, LP
CENTRAL INDEX KEY: 0001688047
STATE OF INCORPORATION: TX
FISCAL YEAR END: 1231
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 000-10093
FILM NUMBER: 18585266
BUSINESS ADDRESS:
STREET 1: 1565 NORTH CENTRAL EXPRESSWAY, SUITE 200
CITY: RICHARDSON
STATE: TX
ZIP: 75080
BUSINESS PHONE: 214-289-9914
MAIL ADDRESS:
STREET 1: 1565 NORTH CENTRAL EXPRESSWAY, SUITE 200
CITY: RICHARDSON
STATE: TX
ZIP: 75080
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
2017-12-29
0
0000319016
Fuse Medical, Inc.
FZMD
0001688047
NC 143 Family Holdings, LP
1565 N. CENTRAL EXPRESSWAY, SUITE 200
RICHARDSON
TX
75080
0
0
1
0
0001693760
Medtech Family Trust
1565 NORTH CENTRAL EXPWY, SUITE 200
RICHARDSON
TX
75080
0
0
1
0
0001693757
NC 143 Family Holdings GP LLC
1565 NORTH CENTRAL EXPWY, SUITE 200
RICHARDSON
TX
75080
0
0
1
0
Common Stock
2016-12-29
4
P
0
50000000
0.20
A
55000000
D
These securities are directly owned by NC 143 Family Holdings, LP, a Texas limited partnership ("NC 143"). However, both the Medtech Family Trust dated October 1, 2014 ("Medtech"), and NC 143 Family Holdings GP LLC (the "GP") indirectly own the reported securities. Medtech is the sole manager of the GP and the GP is the sole general partner of NC 143. Accordingly, both Medtech and the GP indirectly beneficially own the reported securities. This Form 4 is filed jointly by NC 143, Medtech, and the GP.
/s/ Mark W. Brooks
2018-01-26