0001628280-24-024605.txt : 20240521 0001628280-24-024605.hdr.sgml : 20240521 20240521182204 ACCESSION NUMBER: 0001628280-24-024605 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20240517 FILED AS OF DATE: 20240521 DATE AS OF CHANGE: 20240521 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Dilorio Richard CENTRAL INDEX KEY: 0001706994 ORGANIZATION NAME: FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-35020 FILM NUMBER: 24971127 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] ORGANIZATION NAME: 08 Industrial Applications and Services 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 wk-form4_1716330109.xml FORM 4 X0508 4 2024-05-17 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 426817 D Common Stock 2024-05-17 4 A 0 11659 0 A 438476 D Common Stock 2024-05-17 4 F 0 5639 6.44 D 432837 D Common Stock 2024-05-18 4 M 0 14103 0 A 446940 D Common Stock 2024-05-18 4 F 0 6819 6.44 D 440121 D Restricted Stock Units 0 2024-05-17 4 A 0 49685 0 A 2027-05-17 2027-05-17 Common Stock 49685 49685 D Stock Option (right to buy) 6.34 2024-05-17 4 A 0 224817 0 A 2034-05-17 Common Stock 224817 224817 D Restricted Stock Units 2024-05-18 4 M 0 14103 0 D Common Stock 14103 0 D This total includes an additional 1,969 shares acquired recently through the Company's Employee Stock Purchase Plan On May 17, 2024, 11,659 performance-based restricted stock units, granted on May 17, 2022, 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 17, 2024 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, 2024 Restricted stock units convert into common stock on a one-for-one basis. The option, representing the right to purchase a total of 224,817 shares of InfuSystem Holdings, Inc. common stock, vests in four equal annual installments beginning May 17, 2025. These restricted stock units will cliff vested on May 18, 2024. /s/ Kevin Whitman, Attorney-in-Fact for Richard Dilorio 2024-05-21