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