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