0001014108-17-000155.txt : 20170908 0001014108-17-000155.hdr.sgml : 20170908 20170908193229 ACCESSION NUMBER: 0001014108-17-000155 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20170907 FILED AS OF DATE: 20170908 DATE AS OF CHANGE: 20170908 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: 171077643 MAIL ADDRESS: STREET 1: C/O SICOR INC STREET 2: 19 HUGHES CITY: IRVINE STATE: CA ZIP: 92618-1902 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 4 1 primary_doc.xml PRIMARY DOCUMENT X0306 4 2017-09-07 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) 1.98 2017-09-07 4 A 0 25000 0 A 2022-09-07 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 October 7, 2017. /s/Trent N. Smith, Attorney-in-Fact for David C. Dreyer 2017-09-08