0001014108-21-000113.txt : 20210520
0001014108-21-000113.hdr.sgml : 20210520
20210520212604
ACCESSION NUMBER: 0001014108-21-000113
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20210518
FILED AS OF DATE: 20210520
DATE AS OF CHANGE: 20210520
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Shuda Scott
CENTRAL INDEX KEY: 0001486636
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-35020
FILM NUMBER: 21946413
MAIL ADDRESS:
STREET 1: 402 RAILROAD AVENUE, SUITE 201
CITY: DANVILLE
STATE: CA
ZIP: 94526
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: 3851 WEST HAMLIN ROAD
CITY: ROCHESTER HILLS
STATE: MI
ZIP: 48309
BUSINESS PHONE: (248) 291-1210
MAIL ADDRESS:
STREET 1: 3851 WEST HAMLIN ROAD
CITY: ROCHESTER HILLS
STATE: MI
ZIP: 48309
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
2021-05-18
0
0001337013
InfuSystem Holdings, Inc
INFU
0001486636
Shuda Scott
402 RAILROAD AVENUE, SUITE 201
DANVILLE
CA
94526
1
0
1
0
Stock Option (right to buy)
19.5
2021-05-18
4
A
0
35000
0
A
2021-05-18
Common Stock
35000
35000
D
The option, representing the right to purchase a total of 35,000 shares of InfuSystem Holdings, Inc. common stock, vests in twelve monthly installments beginning June 18, 2021
Kevin Whitman
2021-05-20