0001628280-23-030278.txt : 20230822 0001628280-23-030278.hdr.sgml : 20230822 20230822183324 ACCESSION NUMBER: 0001628280-23-030278 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20230821 FILED AS OF DATE: 20230822 DATE AS OF CHANGE: 20230822 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: 231194781 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_169274359330072.xml FORM 4 X0508 4 2023-08-21 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 0 Common Stock 2023-08-21 4 M 0 200000 3.18 A 534198 D Common Stock 2023-08-21 4 F 0 109350 11.14 D 424848 D Stock Options (right to buy) 3.18 2023-08-21 4 M 0 200000 3.18 D 2023-08-23 Common Stock 200000.0 0 D Reflects the number of shares surrendered in connection with the cashless exercise and tax withholding obligations for the exercised option. The option, representing the right to purchase a total of 200,000 shares of InfuSystem Holdings, Inc. common stock, vested in three equal annual installments beginning August 23, 2019. /s/ Kevin Whitman, Attorney-in-Fact for Richard Dilorio 2023-08-22