0001014108-17-000012.txt : 20170127
0001014108-17-000012.hdr.sgml : 20170127
20170127161049
ACCESSION NUMBER: 0001014108-17-000012
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20170118
FILED AS OF DATE: 20170127
DATE AS OF CHANGE: 20170127
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: DREYER DAVID C
CENTRAL INDEX KEY: 0001203607
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-35020
FILM NUMBER: 17553837
MAIL ADDRESS:
STREET 1: C/O SICOR INC
STREET 2: 19 HUGHES
CITY: IRVINE
STATE: CA
ZIP: 92618-1902
4
1
primary_doc.xml
PRIMARY DOCUMENT
X0306
4
2017-01-18
0
0001337013
InfuSystem Holdings, Inc
INFU
0001203607
DREYER DAVID C
C/O INFUSYSTEM HOLDINGS, INC.
31700 RESEARCH PARK DRIVE
MADISON HEIGHTS
MI
48071
1
0
0
0
Stock Option (right to buy)
2.39
2017-01-18
4
A
0
25000
0
A
2027-01-18
Common Stock
25000
25000
D
The option, representing the right to purchase a total of 25,000 shares of InfuSystem Holdings, Inc. common stock, vests in twelve monthly installments beginning February 18, 2017.
/s/Sean Schembri, Attorney-in-Fact for David C. Dreyer
2017-01-27