0001437749-19-006216.txt : 20190401 0001437749-19-006216.hdr.sgml : 20190401 20190401152915 ACCESSION NUMBER: 0001437749-19-006216 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20190328 FILED AS OF DATE: 20190401 DATE AS OF CHANGE: 20190401 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Dilorio Richard CENTRAL INDEX KEY: 0001706994 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-35020 FILM NUMBER: 19720357 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 4 1 rdgdoc.xml FORM 4 X0306 4 2019-03-28 0001337013 InfuSystem Holdings, Inc INFU 0001706994 Dilorio Richard 31700 RESEARCH PARK DRIVE MADISON HEIGHTS MI 48071 1 1 President & CEO Common Stock 2019-03-28 4 M 0 25000 A 117028 D Common Stock 2019-03-28 4 F 0 7350 4.14 D 109678 D Common Stock 2019-03-29 4 M 0 200000 2 A 309678 D Common Stock 2019-03-29 4 F 0 117754 4.79 D 191924 D Stock Appreciation Rights 2 2019-03-29 4 M 0 200000 0 D 2018-12-31 2019-03-31 Common Stock 200000 0 D Restricted Stock Units 2019-03-28 4 M 0 25000 0 D Common Stock 25000 100000 D Represents the acquisition of the Issuer's common stock by reporting person pursuant to the vesting and settlement of a portion of the restricted stock units (RSUs) granted on August 23, 2018. Restricted stock units convert into common stock on a one-for-one basis. Represents the withholding of the Issuer's common stock for the tax liability associated with the vesting and settlement of a portion of the restricted stock units (RSUs) granted on August 23, 2018. Represents the acquisition of the Issuer's common stock by reporting person pursuant to the exercise of the Stock Appreciation Rights granted on November 15, 2017. Represents the difference between the number of the Stock Appreciation Rights exercised and the number of shares issued as a result of the exercise. Represents the withholding of the Issuer's common stock for the tax liability associated with the exercise of the Stock Appreciation Rights granted on November 15, 2017. /s/ Richard DiIorio 2019-04-01