0001628280-22-015216.txt : 20220523 0001628280-22-015216.hdr.sgml : 20220523 20220523165945 ACCESSION NUMBER: 0001628280-22-015216 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20220520 FILED AS OF DATE: 20220523 DATE AS OF CHANGE: 20220523 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: 22952547 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_165333956514776.xml FORM 4 X0306 4 2022-05-20 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 2022-05-20 4 A 0 10000 0 A 116161 D Common Stock 2022-05-20 4 F 0 3935 8.49 D 112226 D Common Stock 2022-05-20 4 A 0 4700 0 A 116926 D Common Stock 2022-05-20 4 F 0 1850 8.49 D 115076 D On May 20, 2022, 10,000 performance-based restricted stock units, granted on May 20, 2020, vested 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 20, 2022 On May 20, 2022, 4,700 performance-based restricted stock units, granted on May 20, 2020, vested /s/ Kevin Whitman, Attorney-in-Fact for Carrie Lachance 2022-05-23