0001140361-15-032853.txt : 20150819 0001140361-15-032853.hdr.sgml : 20150819 20150819172537 ACCESSION NUMBER: 0001140361-15-032853 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20150817 FILED AS OF DATE: 20150819 DATE AS OF CHANGE: 20150819 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: 151064903 4 1 doc1.xml FORM 4 X0306 4 2015-08-17 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 Common Stock 2015-08-17 4 M 0 25000 1.52 A 143003 D Stock option (right to buy) 1.52 2015-08-17 4 M 0 25000 0 D 2015-08-29 Common Stock 25000 0 D The option, representing the right to purchase a total of 25,000 shares, became exercisable in twelve equal monthly installments following the August 29, 2013 date of grant. /s/ Trent Smith, attorney-in-fact 2015-08-19