0001140361-15-042381.txt : 20151119
0001140361-15-042381.hdr.sgml : 20151119
20151119180927
ACCESSION NUMBER: 0001140361-15-042381
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20151117
FILED AS OF DATE: 20151119
DATE AS OF CHANGE: 20151119
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: InfuSystem Holdings, Inc
CENTRAL INDEX KEY: 0001337013
STANDARD INDUSTRIAL CLASSIFICATION: SURGICAL & MEDICAL INSTRUMENTS & APPARATUS [3841]
IRS NUMBER: 203341405
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 31700 RESEARCH PARK DRIVE
CITY: MADISON HEIGHTS
STATE: MI
ZIP: 48071
BUSINESS PHONE: (248) 291-1210
MAIL ADDRESS:
STREET 1: 31700 RESEARCH PARK DRIVE
CITY: MADISON HEIGHTS
STATE: MI
ZIP: 48071
FORMER COMPANY:
FORMER CONFORMED NAME: HAPC, Inc.
DATE OF NAME CHANGE: 20060425
FORMER COMPANY:
FORMER CONFORMED NAME: Healthcare Acquisition Partners Corp.
DATE OF NAME CHANGE: 20050824
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Steen Eric K
CENTRAL INDEX KEY: 0001572871
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-35020
FILM NUMBER: 151244605
MAIL ADDRESS:
STREET 1: C/O INFUSYSTEM HOLDINGS, INC.
STREET 2: 31700 RESEARCH PARK DRIVE
CITY: MADISON HEIGHTS
STATE: MI
ZIP: 48071
4
1
doc1.xml
FORM 4
X0306
4
2015-11-17
0
0001337013
InfuSystem Holdings, Inc
INFU
0001572871
Steen Eric K
C/O INFUSYSTEM HOLDINGS, INC.
31700 RESEARCH PARK DRIVE
MADISON HEIGHTS
MI
48071
1
1
0
0
Chief Executive Officer
Common Stock
2015-11-17
4
P
0
1400
2.91
A
156156
D
Common Stock
2015-11-18
4
P
0
100
2.84
A
156256
D
Common Stock
2015-11-19
4
P
0
961
2.84
A
157217
D
The price reported in Column 4 is a weighted average price. These shares were purchased in multiple transactions at prices ranging from $2.84 to $2.93, inclusive. The reporting person undertakes to provide to InfuSystem Holdings, Inc., any security holder of InfuSystem Holdings, Inc., or the staff of the Securities and Exchange Commission, upon request, full information regarding the number of shares purchased at each separate price within the ranges set forth in this footnote (1).
Includes 9,177 shares acquired under the InfuSystem Holdings, Inc. Employee Stock Purchase Plan.
The price reported in Column 4 is a weighted average price. These shares were purchased in multiple transactions at prices ranging from $2.83 to $2.84, inclusive. The reporting person undertakes to provide to InfuSystem Holdings, Inc., any security holder of InfuSystem Holdings, Inc., or the staff of the Securities and Exchange Commission, upon request, full information regarding the number of shares purchased at each separate price within the ranges set forth in this footnote (3).
/s/ Sean Schembri, attorney-in-fact
2015-11-19