0001437749-18-018380.txt : 20181017
0001437749-18-018380.hdr.sgml : 20181017
20181017125249
ACCESSION NUMBER: 0001437749-18-018380
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20181015
FILED AS OF DATE: 20181017
DATE AS OF CHANGE: 20181017
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: DREYER DAVID C
CENTRAL INDEX KEY: 0001203607
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-35020
FILM NUMBER: 181126009
MAIL ADDRESS:
STREET 1: C/O SICOR INC
STREET 2: 19 HUGHES
CITY: IRVINE
STATE: CA
ZIP: 92618-1902
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
rdgdoc.xml
FORM 4
X0306
4
2018-10-15
1
0001337013
InfuSystem Holdings, Inc
INFU
0001203607
DREYER DAVID C
C/O INFUSYSTEM HOLDINGS, INC.
31700 RESEARCH PARK DRIVE
MADISON HEIGHTS
MI
48071
1
Common Stock
2018-10-15
4
M
0
25000
2.39
A
25000
D
Common Stock
2018-10-15
4
F
0
20538
3.24
D
4462
D
Common Stock
2018-10-15
4
M
0
20833
1.98
A
25295
D
Common Stock
2018-10-15
4
F
0
15330
3.24
D
9965
D
Stock Option (Right to Buy)
2.39
2018-10-15
4
M
0
25000
0
D
2018-01-18
2018-10-19
Common Stock
25000
0
D
Stock Option (Right to Buy)
1.98
2018-10-15
4
M
0
20833
0
D
2018-07-19
2018-10-19
Common Stock
20833
0
D
Reflects the number of shares surrendered in connection with the cashless exercise and tax withholding obligations for the exercised option.
The option, representing the right to purchase a total of 25,000 shares, became exercisable in twelve equal monthly installments following the January 18, 2017 date of grant.
The reporting person ceased to be a Director of the Company on July 19, 2018. The option expires three months after the date Optionee ceased to be a Director of the Company.
The option, representing the right to purchase a total of 20,833 shares, became exercisable in ten equal monthly installments following the September 17, 2017 date of grant. All vesting ceased upon termination of the reporting person's service as a Director of the Company on July 19, 2018.
/s/ David C. Dreyer
2018-10-17