0001437749-19-010306.txt : 20190517
0001437749-19-010306.hdr.sgml : 20190517
20190517092610
ACCESSION NUMBER: 0001437749-19-010306
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20190515
FILED AS OF DATE: 20190517
DATE AS OF CHANGE: 20190517
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Sansone Christopher R.
CENTRAL INDEX KEY: 0001519525
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-35020
FILM NUMBER: 19834334
MAIL ADDRESS:
STREET 1: C/O SANSONE ADVISORS, LLC
STREET 2: 151 BODMAN PLACE, SUITE 100
CITY: RED BANK
STATE: NJ
ZIP: 07701
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
2019-05-15
0001337013
InfuSystem Holdings, Inc
INFU
0001519525
Sansone Christopher R.
C/O INFUSYSTEM HOLDINGS, INC.
31700 RESEARCH PARK DRIVE
MADISON HEIGHTS
MI
48071
1
Stock Option (Right to Buy)
4.70
2019-05-15
4
A
0
25000
0
A
2024-05-15
Common Stock
25000
25000
D
The option, representing the right to purchase a total of 25,000 shares of InfuSystem Holdings, Inc. common stock, vests in twelve equal monthly installments beginning on June 15, 2019.
/s/ Jeanie Latz, Attorney-in-Fact for Christopher R. Sansone
2019-05-17