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