3/A//SEC Filing
Medtech Family Trust 3/A
Accession 0000899243-18-003254
CIK 0000319016other
Filed
Feb 7, 7:00 PM ET
Accepted
Feb 8, 2:55 PM ET
Size
10.9 KB
Accession
0000899243-18-003254
Insider Transaction Report
Form 3/AAmended
NC 143 Family Holdings, LP
10% Owner
Holdings
Promissory Note
Exercise: $0.08From: 2017-01-16→ Common Stock (640,239 underlying)Amended and Restated Promissory Note
Exercise: $0.08From: 2017-01-16→ Common Stock (656,678 underlying)
Medtech Family Trust
10% Owner
Holdings
Amended and Restated Promissory Note
Exercise: $0.08From: 2017-01-16→ Common Stock (656,678 underlying)Promissory Note
Exercise: $0.08From: 2017-01-16→ Common Stock (640,239 underlying)
NC 143 Family Holdings GP LLC
10% Owner
Holdings
Amended and Restated Promissory Note
Exercise: $0.08From: 2017-01-16→ Common Stock (656,678 underlying)Promissory Note
Exercise: $0.08From: 2017-01-16→ Common Stock (640,239 underlying)
Footnotes (5)
- [F1]The Amended and Restated Promissory Note, dated October 19, 2016, made by the Issuer and payable to the order of NC 143 Family Holdings, LP, a Texas limited partnership ("NC 143"), in the principal amount of $50,000 ("NC 143 Note #1") became payable upon demand on December 19, 2016, and will be convertible into shares of common stock of the Issuer on or after January 16, 2017. NC 143 Note #1 does not provide for a stated expiration date.
- [F2]On or after January 16, 2017, NC 143 will have the right to convert all or any portion of the then unpaid principal and interest balance of NC 143 Note #1 into shares of common stock of the Issuer at a conversion price of $0.08 per share. The number of shares reported in box 3 is based on the application of such conversion rate to the amount of principal and interest that will be outstanding on January 16, 2017, if NC 143 Note #1 remains outstanding on such date.
- [F3]These securities are directly owned by NC 143, however both the Medtech Family Trust dated October 1, 2014 ("Medtech"), and NC 143 Family Holdings GP LLC ("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.
- [F4]The Promissory Note, dated October 19, 2016, made by the Issuer and payable to the order of NC 143 in the principal amount of $50,000 ("NC 143 Note #2") became payable upon demand on December 19, 2016 and will be convertible into shares of common stock of the Issuer on or after January 16, 2017. NC 143 Note #2 does not provide for a stated expiration date.
- [F5]On or after January 16, 2017, NC 143 will have the right to convert all or any portion of the then unpaid principal and interest balance of NC 143 Note #2 into shares of common stock of the Issuer at a conversion price of $0.08 per share. The number of shares reported in box 3 is based on the application of such conversion rate to the amount of principal and interest that will be outstanding on January 16, 2017, if NC 143 Note #2 remains outstanding on such date.
Documents
Issuer
Fuse Medical, Inc.
CIK 0000319016
Entity typeother
IncorporatedTX
Related Parties
1- filerCIK 0001693760
Filing Metadata
- Form type
- 3/A
- Filed
- Feb 7, 7:00 PM ET
- Accepted
- Feb 8, 2:55 PM ET
- Size
- 10.9 KB