0001628280-22-014647.txt : 20220517
0001628280-22-014647.hdr.sgml : 20220517
20220517165737
ACCESSION NUMBER: 0001628280-22-014647
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20220517
FILED AS OF DATE: 20220517
DATE AS OF CHANGE: 20220517
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Shuda Scott
CENTRAL INDEX KEY: 0001486636
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-35020
FILM NUMBER: 22935453
MAIL ADDRESS:
STREET 1: 402 RAILROAD AVENUE, SUITE 201
CITY: DANVILLE
STATE: CA
ZIP: 94526
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
wf-form4_165282102066924.xml
FORM 4
X0306
4
2022-05-17
0
0001337013
InfuSystem Holdings, Inc
INFU
0001486636
Shuda Scott
C/O INFUSYSTEM HOLDINGS, INC.
3851 WEST HAMLIN ROAD
ROCHESTER HILLS
MI
48309
1
0
0
0
Common Stock
65494
D
Stock Option (right to buy)
8.58
2022-05-17
4
A
0
35000
0
A
2032-05-17
Common Stock
35000.0
35000
D
The stock option was issued with an exercise price equal to the Fair Value as defined by the 2021 Equity Plan, which is computed as the closing price of the Company's common stock reported on the NYSE American LLC on the date of grant.
The option, representing the right to purchase 35,000 shares of InfuSystem Holdings, Inc. common stock, vests on the date of the 2023 annual shareholder meeting.
/s/ Kevin R. Whitman, Attorney-in-Fact for Scott Shuda
2022-05-17