0001140361-15-020322.txt : 20150515
0001140361-15-020322.hdr.sgml : 20150515
20150515161340
ACCESSION NUMBER: 0001140361-15-020322
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20150513
FILED AS OF DATE: 20150515
DATE AS OF CHANGE: 20150515
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: 31700 RESEARCH PARK DRIVE
CITY: MADISON HEIGHTS
STATE: MI
ZIP: 48071
BUSINESS PHONE: (248) 291-1210
MAIL ADDRESS:
STREET 1: 31700 RESEARCH PARK DRIVE
CITY: MADISON HEIGHTS
STATE: MI
ZIP: 48071
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
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: WHITTERS JOSEPH E
CENTRAL INDEX KEY: 0001186680
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-35020
FILM NUMBER: 15869557
4
1
doc1.xml
FORM 4
X0306
4
2015-05-13
0
0001337013
InfuSystem Holdings, Inc
INFU
0001186680
WHITTERS JOSEPH E
C/O INFUSYSTEM HOLDINGS, INC.
31700 RESEARCH PARK DRIVE
MADISON HEIGHTS
MI
48071
1
0
0
0
Stock option (right to buy)
3.42
2015-05-13
4
A
0
25000
0
A
2020-05-13
Common Stock
25000
25000
D
The option, representing the right to purchase a total of 25,000 shares, vests in twelve equal monthly installments beginning June 13, 2015 and immediately upon a change in control.
/s/ Trent Smith, attorney-in-fact
2015-05-15