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