0001628280-22-014654.txt : 20220517
0001628280-22-014654.hdr.sgml : 20220517
20220517170801
ACCESSION NUMBER: 0001628280-22-014654
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: GENDRON PAUL ANDREW
CENTRAL INDEX KEY: 0001769450
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-35020
FILM NUMBER: 22935670
MAIL ADDRESS:
STREET 1: 740 BANDIT TRAIL
CITY: KELLER
STATE: TX
ZIP: 76248
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_165282164473442.xml
FORM 4
X0306
4
2022-05-17
0
0001337013
InfuSystem Holdings, Inc
INFU
0001769450
GENDRON PAUL ANDREW
C/O INFUSYSTEM HOLDINGS, INC.
3851 WEST HAMLIN ROAD
ROCHESTER HILLS
MI
48309
1
0
0
0
Common Stock
60000
D
Stock Option (right to buy)
8.58
2022-05-17
4
A
0
25000
0
A
2032-05-17
Common Stock
25000.0
25000
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 25,000 shares of InfuSystem Holdings, Inc. common stock, vests on the date of the 2023 annual shareholder meeting.
/s/ Kevin Whitman, Attorney-in-Fact for Paul A. Gendron
2022-05-17