0001014108-21-000117.txt : 20210521
0001014108-21-000117.hdr.sgml : 20210521
20210521111127
ACCESSION NUMBER: 0001014108-21-000117
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20210518
FILED AS OF DATE: 20210521
DATE AS OF CHANGE: 20210521
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: 21947372
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: 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
0001775188
Sheehan Jeannine
31700 RESEARCH PARK DRIVE
MADISON HEIGHTS
MI
48071
0
1
0
0
Chief Administrative Officer
Common Stock
2021-05-18
4
P
0
0
0
A
9164
D
Common Stock
2021-05-18
4
P
0
0
0
A
195
I
By children
Common Stock
2021-05-18
4
P
0
0
0
A
345
I
By children
Stock Option (right to buy)
19.5
2021-05-18
4
A
0
9775
0
A
2031-05-18
Common Stock
9775
9775
D
Restricted Stock Units
2021-05-18
4
A
0
6667
0
A
Common Stock
6667
6667
D
Restricted Stock Units
2021-05-18
4
A
0
2821
0
A
Common Stock
2281
2281
D
The option, representing the right to purchase a total of 9,775 shares of InfuSystem Holdings, Inc. common stock, vests in three equal annual installments beginning May 18, 2022.
Restricted stock units convert into common stock on a one-for-one basis.
These restricted stock units will cliff vest on May 18, 2024.
These restricted stock units will cliff vest on May 18, 2022.
Kevin Whitman
2021-05-21