0001628280-22-015082.txt : 20220520
0001628280-22-015082.hdr.sgml : 20220520
20220520181635
ACCESSION NUMBER: 0001628280-22-015082
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: Sheehan Jeannine
CENTRAL INDEX KEY: 0001775188
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-35020
FILM NUMBER: 22949110
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_165308497650915.xml
FORM 4
X0306
4
2022-05-18
0
0001337013
InfuSystem Holdings, Inc
INFU
0001775188
Sheehan Jeannine
C/O INFUSYSTEM HOLDINGS, INC.
3851 WEST HAMLIN ROAD
ROCHESTER HILLS
MI
48309
0
1
0
0
Chief Administrative Officer
Common Stock
2022-05-18
4
M
0
2821
0
A
21973
D
Common Stock
2022-05-18
4
F
0
1252
8.45
D
20721
D
Common Stock
2022-05-18
4
A
0
9744
0
A
30465
D
Common Stock
2022-05-18
4
F
0
4419
8.45
D
26046
D
Common Stock
345
I
By children
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
The reporting person disclaims beneficial ownership of these securities, and this report shall not be deemed an admission that the reporting person is the beneficial owner of such securities for purposes of Section 16 or for any other purpose.
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 Jeannine Sheehan
2022-05-20