0001445866-19-001110.txt : 20190906
0001445866-19-001110.hdr.sgml : 20190906
20190906164223
ACCESSION NUMBER: 0001445866-19-001110
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20190905
FILED AS OF DATE: 20190906
DATE AS OF CHANGE: 20190906
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Shuda Scott
CENTRAL INDEX KEY: 0001486636
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-35020
FILM NUMBER: 191080079
MAIL ADDRESS:
STREET 1: 402 RAILROAD AVENUE, SUITE 201
CITY: DANVILLE
STATE: CA
ZIP: 94526
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Meridian OHC LLC
CENTRAL INDEX KEY: 0001601538
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-35020
FILM NUMBER: 191080080
BUSINESS ADDRESS:
STREET 1: 405 WEED STREET
CITY: NEW CANAAN
STATE: CT
ZIP: 06840
BUSINESS PHONE: 203-643-9300
MAIL ADDRESS:
STREET 1: 405 WEED STREET
CITY: NEW CANAAN
STATE: CT
ZIP: 06840
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: TSV Investment Partners, LLC
CENTRAL INDEX KEY: 0001603326
STATE OF INCORPORATION: CT
FISCAL YEAR END: 1231
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-35020
FILM NUMBER: 191080081
BUSINESS ADDRESS:
STREET 1: 405 WEED STREET
CITY: NEW CANAAN
STATE: CT
ZIP: 06840
BUSINESS PHONE: 203-643-9300
MAIL ADDRESS:
STREET 1: 405 WEED STREET
CITY: NEW CANAAN
STATE: CT
ZIP: 06840
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Meridian TSV II, LP
CENTRAL INDEX KEY: 0001601536
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-35020
FILM NUMBER: 191080082
BUSINESS ADDRESS:
STREET 1: 405 WEED STREET
CITY: NEW CANAAN
STATE: CT
ZIP: 06840
BUSINESS PHONE: 203-643-9300
MAIL ADDRESS:
STREET 1: 405 WEED STREET
CITY: NEW CANAAN
STATE: CT
ZIP: 06840
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: BlueLine Capital Partners II, L.P.
CENTRAL INDEX KEY: 0001460781
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-35020
FILM NUMBER: 191080083
BUSINESS ADDRESS:
STREET 1: 3480 BUSKIRK AVENUE
STREET 2: SUITE 214
CITY: PLEASANT HILL
STATE: CA
ZIP: 94523
BUSINESS PHONE: 925-236-9790
MAIL ADDRESS:
STREET 1: 3480 BUSKIRK AVENUE
STREET 2: SUITE 214
CITY: PLEASANT HILL
STATE: CA
ZIP: 94523
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: BlueLine Capital Partners, L.P.
CENTRAL INDEX KEY: 0001338149
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-35020
FILM NUMBER: 191080084
BUSINESS ADDRESS:
STREET 1: 3480 BUSKIRK AVENUE
STREET 2: SUITE 214
CITY: PLEASANT HILL
STATE: CA
ZIP: 94523
BUSINESS PHONE: 925-648-2085
MAIL ADDRESS:
STREET 1: 3480 BUSKIRK AVENUE
STREET 2: SUITE 214
CITY: PLEASANT HILL
STATE: CA
ZIP: 94523
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
4
1
form4.xml
PRIMARY DOCUMENT
X0306
4
2019-09-05
0
0001337013
InfuSystem Holdings, Inc
INFU
0001486636
Shuda Scott
C/O INFUSYSTEM HOLDINGS, INC.,
31700 RESEARCH PARK DRIVE
MADISON HEIGHTS
MI
48701
1
0
1
0
0001601538
Meridian OHC LLC
425 WEED STREET
NEW CANAAN
CT
06840
0
0
1
0
0001603326
TSV Investment Partners, LLC
425 WEED STREET
NEW CANAAN
CT
06840
0
0
1
0
0001601536
Meridian TSV II, LP
425 WEED STREET
NEW CANAAN
CT
06840
0
0
1
0
0001460781
BlueLine Capital Partners II, L.P.
3480 BUSKIRK AVENUE
SUITE 214
PLEASANT HILL
CA
94523
0
0
1
0
0001338149
BlueLine Capital Partners, L.P.
3480 BUSKIRK AVENUE
SUITE 214
PLEASANT HILL
CA
94523
0
0
1
0
Common Stock
2019-09-05
4
P
0
1004.0000
4.9000
A
3522521.0000
D
Common Stock
2019-09-05
4
P
0
2000.0000
5.0000
A
3524521.0000
D
Common Stock
2019-09-06
4
P
0
2000.0000
5.0500
A
3526521.0000
D
These securities are owned by BlueLine Capital Partners II, LP.
/s/ Scott Shuda
2019-09-06