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