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