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