0001437749-19-002934.txt : 20190220
0001437749-19-002934.hdr.sgml : 20190220
20190220151441
ACCESSION NUMBER: 0001437749-19-002934
CONFORMED SUBMISSION TYPE: 3
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20190212
FILED AS OF DATE: 20190220
DATE AS OF CHANGE: 20190220
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: RUIZ THOMAS MARK
CENTRAL INDEX KEY: 0001768484
FILING VALUES:
FORM TYPE: 3
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-35020
FILM NUMBER: 19618050
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
3
1
rdgdoc.xml
FORM3
X0206
3
2019-02-12
0
0001337013
InfuSystem Holdings, Inc
INFU
0001768484
RUIZ THOMAS MARK
31700 RESEARCH PARK DRIVE
MADISON HEIGHTS
MI
48071
1
VP OF SALES AND MARKETING
Common Stock
5337
D
Stock Option (Right to Buy)
2.6900
2017-07-31
2024-12-08
Common Stock
50000
D
Stock Option (Right to Buy)
2.7600
2026-08-18
Common Stock
40000
D
Stock Option (Right to Buy)
2.1500
2027-03-15
Common Stock
25000
D
Stock Option (Right to Buy)
1.9800
2022-09-06
Common Stock
25000
D
Stock Option (Right to Buy)
3.3600
2023-07-19
Common Stock
25000
D
Restricted Stock Units
2019-03-11
2019-03-12
Common Stock
2083
D
The option, representing the right to purchase a total of 40,000 shares, became exercisable in 36 equal monthly installments following the August 18, 2016 date of grant.
The option, representing the right to purchase a total of 25,000 shares, became exercisable in 36 equal monthly installments following the March 16, 2017 date of grant.
Stock option vests 33% per year on anniversary date starting September 7, 2018
Stock option vests 33% per year on anniversary date starting July 19, 2019
Restricted stock units convert into common stock on a one-for-one basis.
The reporting person was awarded restricted stock units on March 11, 2015, which vest in one remaining annual installment on March 11th of 2019. Settlement of the underlying shares of common stock will occur on vesting date, assuming continued employment through the applicable vesting date.
/s/ Thomas M. Ruiz
2019-02-20