0001628280-22-016889.txt : 20220610
0001628280-22-016889.hdr.sgml : 20220610
20220610181131
ACCESSION NUMBER: 0001628280-22-016889
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20220607
FILED AS OF DATE: 20220610
DATE AS OF CHANGE: 20220610
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: RUIZ THOMAS MARK
CENTRAL INDEX KEY: 0001768484
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-35020
FILM NUMBER: 221010174
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_165489907583598.xml
FORM 4
X0306
4
2022-06-07
0
0001337013
InfuSystem Holdings, Inc
INFU
0001768484
RUIZ THOMAS MARK
C/O INFUSYSTEM HOLDINGS, INC.
3851 WEST HAMLIN ROAD
ROCHESTER HILLS
MI
48309
0
1
0
0
Chief Commercial Officer
Common Stock
2022-06-07
4
M
0
15000
1.98
A
47893
D
Common Stock
2022-06-07
4
S
0
15000
9.88
D
32893
D
Stock Option (right to buy)
1.98
2022-06-07
4
M
0
15000
0
D
2022-09-06
Common Stock
15000.0
10000
D
The price reported in Column 4 is a weighted average price. These shares reported herein were sold in multiple transactions. The reporting person undertakes to provide to the Issuer, and security holder of the Issuer, or the staff of the Securities and Exchange Commission, upon request, full information regarding the number of shares sold at each separate price.
Stock option vests 33% per year on anniversary date starting September 7, 2018
/s/ Kevin Whitman, Attorney-in-Fact for Tom Ruiz
2022-06-10