0001288136-11-000048.txt : 20110310
0001288136-11-000048.hdr.sgml : 20110310
20110310093855
ACCESSION NUMBER: 0001288136-11-000048
CONFORMED SUBMISSION TYPE: SC 13G/A
PUBLIC DOCUMENT COUNT: 1
FILED AS OF DATE: 20110310
DATE AS OF CHANGE: 20110310
SUBJECT COMPANY:
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
FILING VALUES:
FORM TYPE: SC 13G/A
SEC ACT: 1934 Act
SEC FILE NUMBER: 005-81749
FILM NUMBER: 11676980
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
FILED BY:
COMPANY DATA:
COMPANY CONFORMED NAME: Pine River Capital Management L.P.
CENTRAL INDEX KEY: 0001288136
IRS NUMBER: 710868907
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
FILING VALUES:
FORM TYPE: SC 13G/A
BUSINESS ADDRESS:
STREET 1: 601 CARLSON PARKWAY
STREET 2: SUITE 330
CITY: MINNETONKA
STATE: MN
ZIP: 55305
BUSINESS PHONE: 6122383300
MAIL ADDRESS:
STREET 1: 601 CARLSON PARKWAY
STREET 2: SUITE 330
CITY: MINNETONKA
STATE: MN
ZIP: 55305
FORMER COMPANY:
FORMER CONFORMED NAME: Pine River Capital Management, L.P.
DATE OF NAME CHANGE: 20040512
FORMER COMPANY:
FORMER CONFORMED NAME: NISSWA MASTER FUND LTD
DATE OF NAME CHANGE: 20040422
SC 13G/A
1
infu031011nmf.txt
SECURITIES AND EXCHANGE COMMISSION
WASHINGTON, DC 20549
SCHEDULE 13G
(Rule 13d-102)
INFORMATION TO BE INCLUDED IN STATEMENTS FILED PURSUANT
TO RULES 13d-1(b)(c), AND (d) AND AMENDMENTS THERETO FILED
PURSUANT TO RULE 13d-2(b)
(Amendment No. 3)
InfuSystem Holdings, Inc.
-------------------------------------------------------------------------------
(Name of Issuer)
Common Stock, $.0001 Par Value
-------------------------------------------------------------------------------
(Title of Class of Securities)
45685K102
-------------------------------------------------------------------------------
(CUSIP Number)
December 31, 2010
-------------------------------------------------------------------------------
(Date of Event Which Requires Filing of this Statement)
Check the appropriate box to designate the rule pursuant to which this
Schedule is filed:
[ ] Rule 13d-1(b)
[x] Rule 13d-1(c)
[ ] Rule 13d-1(d)
CUSIP No. 45685K102
---------------------
1. NAME OF REPORTING PERSONS
I.R.S. IDENTIFICATION NO. OF ABOVE PERSONS (ENTITIES ONLY)
Brian Taylor
2. CHECK THE APPROPRIATE BOX IF A MEMBER OF A GROUP
(a) [_]
(b) [x]
3. SEC USE ONLY
4. CITIZENSHIP OR PLACE OF ORGANIZATION
United States
NUMBER OF SHARES BENEFICIALLY OWNED BY EACH REPORTING PERSON WITH
5. SOLE VOTING POWER
0
6. SHARED VOTING POWER
0
7. SOLE DISPOSITIVE POWER
0
8. SHARED DISPOSITIVE POWER
0
9. AGGREGATE AMOUNT BENEFICIALLY OWNED BY EACH REPORTING PERSON
0
10. CHECK BOX IF THE AGGREGATE AMOUNT IN ROW (9) EXCLUDES CERTAIN SHARES
[_]
11. PERCENT OF CLASS REPRESENTED BY AMOUNT IN ROW 9
0%
12. TYPE OF REPORTING PERSON
IN
CUSIP No. 45685K102
---------------------
1. NAME OF REPORTING PERSONS
I.R.S. IDENTIFICATION NO. OF ABOVE PERSONS (ENTITIES ONLY)
Pine River Capital Management L.P.
2. CHECK THE APPROPRIATE BOX IF A MEMBER OF A GROUP
(a) [_]
(b) [x]
3. SEC USE ONLY
4. CITIZENSHIP OR PLACE OF ORGANIZATION
Delaware, United States
NUMBER OF SHARES BENEFICIALLY OWNED BY EACH REPORTING PERSON WITH
5. SOLE VOTING POWER
0
6. SHARED VOTING POWER
0
7. SOLE DISPOSITIVE POWER
0
8. SHARED DISPOSITIVE POWER
0
9. AGGREGATE AMOUNT BENEFICIALLY OWNED BY EACH REPORTING PERSON
0
10. CHECK BOX IF THE AGGREGATE AMOUNT IN ROW (9) EXCLUDES CERTAIN SHARES
[_]
11. PERCENT OF CLASS REPRESENTED BY AMOUNT IN ROW 9
0%
12. TYPE OF REPORTING PERSON
PN
CUSIP No. 45685K102
---------------------
1. NAME OF REPORTING PERSONS
I.R.S. IDENTIFICATION NOS. OF ABOVE PERSONS (ENTITIES ONLY)
Nisswa Master Fund Ltd.
2. CHECK THE APPROPRIATE BOX IF A MEMBER OF A GROUP (SEE INSTRUCTIONS)
(a) [_]
(b) [X]
3. SEC USE ONLY
4. CITIZENSHIP OR PLACE OF ORGANIZATION
Cayman Islands
NUMBER OF SHARES BENEFICIALLY OWNED BY EACH REPORTING PERSON WITH
5. SOLE VOTING POWER
0
6. SHARED VOTING POWER
0
7. SOLE DISPOSITIVE POWER
0
8. SHARED DISPOSITIVE POWER
0
9. AGGREGATE AMOUNT BENEFICIALLY OWNED BY EACH REPORTING PERSON
0
10. CHECK BOX IF THE AGGREGATE AMOUNT IN ROW (9) EXCLUDES CERTAIN
SHARES (SEE INSTRUCTIONS)
[_]
11. PERCENT OF CLASS REPRESENTED BY AMOUNT IN ROW 9
0%
12. TYPE OF REPORTING PERSON (SEE INSTRUCTIONS)
CO
-------------------------------------------------------------------------------
CUSIP No. 45685K102
---------------------
Item 1(a). Name of Issuer:
InfuSystem Holdings, Inc.
--------------------------------------------------------------------
Item 1(b). Address of Issuer's Principal Executive Offices:
31700 Research Park Drive
Madison Heights, MI 48071
--------------------------------------------------------------------
Item 2(a). Name of Persons Filing:
Brian Taylor
Pine River Capital Management L.P.
Nisswa Master Fund Ltd.
--------------------------------------------------------------------
Item 2(b). Address of Principal Business Office, or if None, Residence:
Brian Taylor
Pine River Capital Management L.P.
601 Carlson Parkway
Suite 330
Minnetonka, MN 55305
Nisswa Master Fund Ltd.
c/o Pine River Capital Management L.P.
601 Carlson Parkway
Suite 330
Minnetonka, MN 55305
--------------------------------------------------------------------
Item 2(c). Citizenship:
Brian Taylor - United States
Pine River Capital Management L.P. - Delaware, United States
Nisswa Master Fund Ltd. - Cayman Islands
--------------------------------------------------------------------
Item 2(d). Title of Class of Securities:
Common Stock, $.0001 Par Value
--------------------------------------------------------------------
Item 2(e). CUSIP Number:
45685K102
--------------------------------------------------------------------
Item 3. If This Statement is Filed Pursuant to Rule 13d-1(b), or 13d-2(b)
or (c), Check Whether the Person Filing is a:
(a) [_] Broker or dealer registered under Section 15 of the Exchange Act.
(b) [_] Bank as defined in Section 3(a)(6) of the Exchange Act.
(c) [_] Insurance company as defined in Section 3(a)(19) of the Exchange
Act.
(d) [_] Investment company registered under Section 8 of the Investment
Company Act.
(e) [_] An investment adviser in accordance with Rule 13d-1(b)(1)(ii)(E);
(f) [_] An employee benefit plan or endowment fund in accordance with
Rule 13d-1(b)(1)(ii)(F);
(g) [_] A parent holding company or control person in accordance with
Rule 13d-1(b)(1)(ii)(G);
(h) [_] A savings association as defined in Section 3(b) of the Federal
Deposit Insurance Act;
(i) [_] A church plan that is excluded from the definition of an
investment company under Section 3(c)(14) of the Investment
Company Act;
(j) [_] Group, in accordance with Rule 13d-1(b)(1)(ii)(J).
Item 4. Ownership.
Provide the following information regarding the aggregate number and
percentage of the class of securities of the issuer identified in Item 1.
(a) Amount beneficially owned:
Brian Taylor - 0
Pine River Capital Management L.P. - 0
Nisswa Master Fund Ltd. - 0
----------------------------------------------------------------------
(b) Percent of class:
Brian Taylor - 0%
Pine River Capital Management L.P. - 0%
Nisswa Master Fund Ltd. - 0%
----------------------------------------------------------------------
(c) Number of shares as to which such person has:
(i) Sole power to vote or to direct the vote:
Brian Taylor - 0
Pine River Capital Management L.P. - 0
Nisswa Master Fund Ltd. - 0
(ii) Shared power to vote or to direct the vote:
Brian Taylor - 0
Pine River Capital Management L.P. - 0
Nisswa Master Fund Ltd. - 0
(iii) Sole power to dispose or to direct the disposition of:
Brian Taylor - 0
Pine River Capital Management L.P. - 0
Nisswa Master Fund Ltd. - 0
(iv) Shared power to dispose or to direct the disposition of:
Brian Taylor - 0
Pine River Capital Management L.P. - 0
Nisswa Master Fund Ltd. - 0
Item 5. Ownership of Five Percent or Less of a Class.
If this statement is being filed to report the fact that as of the date
hereof the reporting person has ceased to be the beneficial owner of
more than five percent of the class of securities check the following
[X].
-----------------------------------------------------------------------
Item 6. Ownership of More Than Five Percent on Behalf of Another Person.
N/A
-----------------------------------------------------------------------
Item 7. Identification and Classification of the Subsidiary Which Acquired the
Security Being Reported on by the Parent Holding Company or Control
Person.
N/A
-----------------------------------------------------------------------
Item 8. Identification and Classification of Members of the Group.
N/A
----------------------------------------------------------------------
Item 9. Notice of Dissolution of Group.
N/A
-----------------------------------------------------------------------
Item 10. Certifications.
By signing below, each reporting person certifies that, to the best of
its knowledge and belief, the securities referred to above were not acquired and
are not held for the purpose of or with the effect of changing or influencing
the control of the issuer of the securities and were not acquired and are not
held in connection with or as a participant in any transaction having that
purpose or effect.
SIGNATURE
After reasonable inquiry and to the best of my knowledge and belief, I
certify that the information set forth in this statement is true, complete and
correct.
/s/ Brian Taylor*
---------------------
Brian Taylor
PINE RIVER CAPITAL MANAGEMENT L.P.*
By: Pine River Capital Management LLC, its general partner
/s/ Brian Taylor
---------------------
By: Brian Taylor
Title: Sole Member
Nisswa Master Fund Ltd.*
/s/ Brian Taylor
----------------------
By: Brian Taylor
Title: Director
Date: March 10, 2011
*The Reporting Persons disclaim beneficial ownership in the common stock
reported herein except to the extent of their pecuniary interest therein.
EXHIBIT A
AGREEMENT
The undersigned agree that this Schedule 13G dated March 10, 2011 relating to
the Common Stock, $.0001 Par Value of InfuSystem Holdings, Inc. shall be filed
on behalf of the undersigned.
/s/ Brian Taylor
---------------------
Brian Taylor
PINE RIVER CAPITAL MANAGEMENT L.P.
By: Pine River Capital Management LLC, its general partner
/s/ Brian Taylor
---------------------
By: Brian Taylor
Title: Sole Member
Nisswa Master Fund Ltd.
/s/ Brian Taylor
---------------------
By: Brian Taylor
Title: Director