0000899243-22-038909.txt : 20221216
0000899243-22-038909.hdr.sgml : 20221216
20221216210241
ACCESSION NUMBER: 0000899243-22-038909
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20221215
FILED AS OF DATE: 20221216
DATE AS OF CHANGE: 20221216
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Brooks Mark W
CENTRAL INDEX KEY: 0001688048
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 000-10093
FILM NUMBER: 221469432
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
2022-12-15
0
0000319016
Fuse Medical, Inc.
FZMD
0001688048
Brooks Mark W
1004 EXCALIBUR BLVD
LEWISVILLE
TX
75056
1
1
1
0
President Chairman
Common Stock
2022-12-15
5
A
0
E
333333
0.15
A
882586
D
On December 15, 2022 the Reporting Person was issued 333,333 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 Amended and Restated 2018 Equity Incentive Plan of Fuse Medical Inc. (the "2018 Plan") (incorporated by reference to Exhibit 10.1 of the Issuer's Form 8-K filed with the Securities and Exchange Commission (the "SEC") on December 18, 2018 (File No. 000-100093)), subject to the terms and conditions in the 2018 Plan.
(Continued From Footnote I) 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"): (A) the listing of the Company's Common Stock on either the NYSE or the NASDAQ Stock Market; or (B) a change in Control (as defined in the 2018 Plan); and (ii) the delivery by the Reporting Person to our company of a Notice of Acceleration of Vesting (as defined in award agreement) no later than sixty (60) days following the earlier of (A) the date our Company sends written notice of such Accelerating Event or (B) the date the Reporting Person actually or constructively becomes aware that such Accelerating Event has occurred.
/s/ Mark W Brooks
2022-12-16