-----BEGIN PRIVACY-ENHANCED MESSAGE----- Proc-Type: 2001,MIC-CLEAR Originator-Name: webmaster@www.sec.gov Originator-Key-Asymmetric: MFgwCgYEVQgBAQICAf8DSgAwRwJAW2sNKK9AVtBzYZmr6aGjlWyK3XmZv3dTINen TWSM7vrzLADbmYQaionwg5sDW3P6oaM5D3tdezXMm7z1T+B+twIDAQAB MIC-Info: RSA-MD5,RSA, ApS2CHHJKWQTVmIdXhTzXi1J/QFYROTW+lfl8VP+UoViS11RfMuuyjZ9JYTT12St CbtAk/+FKOlt5TBVH9Ag+A== 0001181431-10-017980.txt : 20100324 0001181431-10-017980.hdr.sgml : 20100324 20100324141315 ACCESSION NUMBER: 0001181431-10-017980 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20100322 FILED AS OF DATE: 20100324 DATE AS OF CHANGE: 20100324 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: MILLON JEAN PIERRE CENTRAL INDEX KEY: 0001190016 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-51902 FILM NUMBER: 10701410 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: 1551 EAST LINCOLN AVENUE, SUITE 200 CITY: MADISON HEIGHTS STATE: MI ZIP: 48071 BUSINESS PHONE: (248) 546-7047 MAIL ADDRESS: STREET 1: 1551 EAST LINCOLN AVENUE, SUITE 200 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 rrd270910.xml FORM 4 X0303 4 2010-03-22 0 0001337013 InfuSystem Holdings, Inc INHI.OB 0001190016 MILLON JEAN PIERRE C/O INFUSYSTEM HOLDINGS, INC. 31700 RESEARCH PARK DRIVE MADISON HEIGHTS MI 48071 1 0 0 0 Warrants to Purchase Common Shares 2010-03-22 4 S 0 42858 0 D 267092 D Class A Common Stock, par value $0.0001 per share 2010-03-22 4 P 0 1714 0 A 268806 D Represents Mr. Millon's tender of 42,858 warrants to purchase common stock par value $0.0001 per share ("Common Stock") of InfuSystem Holdings, Inc. (the "Company") exercisable at $5.00 per share (the "Warrants") pursuant an offer by the Company to exchange (the "Exchange Offer") any and all Warrants for shares of the Company's Common Stock, upon the terms and subject to the conditions set forth in the Company's Exchange Offer, dated February 16, 2010. Represents the 1,714 shares of Common Stock Mr. Millon received in exchange for the 42,858 Warrants tendered at a ratio of 25 to 1 for shares of Common Stock subject to a lock-up as described in the Exchange Offer materials. /s/ Jean-Pierre Millon 2010-03-24 -----END PRIVACY-ENHANCED MESSAGE-----