0001628280-22-015081.txt : 20220520 0001628280-22-015081.hdr.sgml : 20220520 20220520181613 ACCESSION NUMBER: 0001628280-22-015081 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20220518 FILED AS OF DATE: 20220520 DATE AS OF CHANGE: 20220520 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Lachance Carrie CENTRAL INDEX KEY: 0001790024 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-35020 FILM NUMBER: 22949108 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: 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_165308495006894.xml FORM 4 X0306 4 2022-05-18 0 0001337013 InfuSystem Holdings, Inc INFU 0001790024 Lachance Carrie C/O INFUSYSTEM HOLDINGS, INC. 3851 WEST HAMLIN ROAD ROCHESTER HILLS MI 48309 1 1 0 0 President and COO Common Stock 2022-05-18 4 M 0 2821 0 A 101333 D Common Stock 2022-05-18 4 F 0 1111 8.45 D 100222 D Common Stock 2022-05-18 4 A 0 9744 0 A 109966 D Common Stock 2022-05-18 4 F 0 3805 8.45 D 106161 D Restricted Stock Units 2022-05-18 4 M 0 2821 0 D Common Stock 2821.0 0 D Represents the withholding of the Issuer's common stock for the tax liability associated with the vesting and settlement of the common stock issued on May 18, 2022 On May 18, 2022, 9,744 performance-based restricted stock units, granted on May 18, 2021, vested Restricted stock units convert into common stock on a one-for-one basis. These restricted stock units cliff vested on May 18, 2022. /s/ Kevin Whitman, Attorney-in-Fact for Carrie Lachance 2022-05-20