0001014108-21-000029.txt : 20210211
0001014108-21-000029.hdr.sgml : 20210211
20210211210123
ACCESSION NUMBER: 0001014108-21-000029
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20210209
FILED AS OF DATE: 20210211
DATE AS OF CHANGE: 20210211
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Sheehan Jeannine
CENTRAL INDEX KEY: 0001775188
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-35020
FILM NUMBER: 21622131
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
2021-02-09
0
0001337013
InfuSystem Holdings, Inc
INFU
0001775188
Sheehan Jeannine
3851 WEST HAMLIN ROAD
ROCHESTER HILLS
MI
48309
0
1
0
0
Chief Administrative Officer
Common Stock
2021-02-09
4
A
0
2678
0
A
8811
D
Common Stock
195
I
By children
Common Stock
345
I
By children
The reported shares were issued as part of the issuer's Short Term Incentive ("STI") plan relating to the issuer's 2020 performance. The issuer's board of directors decided that a portion of the award determined payable to the issuer's executive team would be payable in the form of fully-vested shares of the issuer's common stock. Such shares are issued under the issuer's 2014 Equity Plan.
This total includes an additional 483 shares acquired recently through the Company's Employee Stock Purchase Plan.
The reporting person disclaims beneficial ownership of these securities, and this report shall not be deemed an admission that the reporting person is the beneficial owner of such securities for purposes of Section 16 or for any other purpose.
/s/Kevin Whitman, Attorney-in-Fact for Jeannine Sheehan
2021-02-11