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