0001140361-15-020323.txt : 20150515 0001140361-15-020323.hdr.sgml : 20150515 20150515161351 ACCESSION NUMBER: 0001140361-15-020323 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: DREYER DAVID C CENTRAL INDEX KEY: 0001203607 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-35020 FILM NUMBER: 15869564 MAIL ADDRESS: STREET 1: C/O SICOR INC STREET 2: 19 HUGHES CITY: IRVINE STATE: CA ZIP: 92618-1902 4 1 doc1.xml FORM 4 X0306 4 2015-05-13 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) 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