0001014108-21-000194.txt : 20211112 0001014108-21-000194.hdr.sgml : 20211112 20211112183824 ACCESSION NUMBER: 0001014108-21-000194 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20211111 FILED AS OF DATE: 20211112 DATE AS OF CHANGE: 20211112 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: GENDRON PAUL ANDREW CENTRAL INDEX KEY: 0001769450 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-35020 FILM NUMBER: 211405483 MAIL ADDRESS: STREET 1: 740 BANDIT TRAIL CITY: KELLER STATE: TX ZIP: 76248 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 2021-11-11 0 0001337013 InfuSystem Holdings, Inc INFU 0001769450 GENDRON PAUL ANDREW C/O INFUSYSTEM HOLDINGS, INC. 3851 WEST HAMLIN ROAD ROCHESTER HILLS MI 48309 1 0 0 0 Common Stock 2021-11-11 4 M 0 25000 4.7 A 50000 D Stock Option (right to buy) 4.7 2021-11-11 4 M 0 25000 0 D 2020-05-15 2024-05-15 Common Stock 25000 0 D /s/ Kevin Whitman, Attorney-in-Fact for Paul A. Gendron 2021-11-12