0001628280-22-015220.txt : 20220523
0001628280-22-015220.hdr.sgml : 20220523
20220523170114
ACCESSION NUMBER: 0001628280-22-015220
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: Dilorio Richard
CENTRAL INDEX KEY: 0001706994
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-35020
FILM NUMBER: 22952597
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_165333962046051.xml
FORM 4
X0306
4
2022-05-20
0
0001337013
InfuSystem Holdings, Inc
INFU
0001706994
Dilorio Richard
C/O INFUSYSTEM HOLDINGS, INC.
3851 WEST HAMLIN ROAD
ROCHESTER HILLS
MI
48309
1
1
0
0
Chief Executive Officer
Common Stock
2022-05-20
4
A
0
15000
0
A
263684
D
Common Stock
2022-05-20
4
F
0
6653
8.49
D
257031
D
Common Stock
2022-05-20
4
A
0
7050
0
A
264081
D
Common Stock
2022-05-20
4
F
0
3127
8.49
D
260954
D
On May 20, 2022, 15,000 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, 7,050 performance-based restricted stock units, granted on May 20, 2020, vested
/s/ Kevin Whitman, Attorney-in-Fact for Richard Dilorio
2022-05-23