0001014108-18-000195.txt : 20180827
0001014108-18-000195.hdr.sgml : 20180827
20180827173717
ACCESSION NUMBER: 0001014108-18-000195
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20180823
FILED AS OF DATE: 20180827
DATE AS OF CHANGE: 20180827
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Dilorio Richard
CENTRAL INDEX KEY: 0001706994
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-35020
FILM NUMBER: 181039728
MAIL ADDRESS:
STREET 1: 31700 RESEARCH PARK DRIVE
CITY: MADISON HEIGHTS
STATE: MI
ZIP: 48071
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
primary_doc.xml
PRIMARY DOCUMENT
X0306
4
2018-08-23
0
0001337013
InfuSystem Holdings, Inc
INFU
0001706994
Dilorio Richard
31700 RESEARCH PARK DRIVE
MADISON HEIGHTS
MI
48071
1
1
0
0
Chief Executive Officer
Restricted Stock Units
2018-08-23
4
A
0
125000
0
A
2021-08-23
Common Stock
125000
125000
D
Stock Option (right to buy)
3.18
2018-08-23
4
A
0
200000
0
A
2023-08-23
Common Stock
200000
200000
D
Restricted stock units convert into common stock on a one-for-one basis.
These restricted stock units are eligible for vesting over a three-year period beginning August 23, 2018. The first 25,000 will vest if the company's closing stock price is above $4.00 for ten consecutive trading days prior to the one year anniversary of the grant. An additional 50,000 will vest if the company's closing stock price is above $5.00 for ten consecutive trading days prior to the two year anniversary of the grant. An additional 50,000 will vest if the company's closing stock price is above $6.00 for ten consecutive trading days prior to the three year anniversary of the grant.
The option, representing the right to purchase a total of 200,000 shares of InfuSystem Holdings, Inc. common stock, vests in three annual installments beginning on August 23, 2019.
/s/Richard Dilorio
2018-08-27