0001628280-22-014648.txt : 20220517 0001628280-22-014648.hdr.sgml : 20220517 20220517165845 ACCESSION NUMBER: 0001628280-22-014648 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20220517 FILED AS OF DATE: 20220517 DATE AS OF CHANGE: 20220517 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: BOYD RALPH F JR CENTRAL INDEX KEY: 0001269702 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-35020 FILM NUMBER: 22935476 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: 3851 WEST HAMLIN ROAD CITY: ROCHESTER HILLS STATE: MI ZIP: 48309 BUSINESS PHONE: (248) 291-1210 MAIL ADDRESS: STREET 1: 3851 WEST HAMLIN ROAD CITY: ROCHESTER HILLS STATE: MI ZIP: 48309 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 wf-form4_165282106762242.xml FORM 4 X0306 4 2022-05-17 0 0001337013 InfuSystem Holdings, Inc INFU 0001269702 BOYD RALPH F JR 3851 WEST HAMLIN ROAD ROCHESTER HILLS MI 48309 1 0 0 0 Stock Option (right to buy) 8.58 2022-05-17 4 A 0 25000 0 A 2032-05-17 Common Stock 25000.0 25000 D The stock option was issued with an exercise price equal to the Fair Value as defined by the 2021 Equity Plan, which is computed as the closing price of the Company's common stock reported on the NYSE American LLC on the date of grant. The option, representing the right to purchase 25,000 shares of InfuSystem Holdings, Inc. common stock, vests on the date of the 2023 annual shareholder meeting. /s/ Kevin Whitman, Attorney-in-Fact for Ralph F. Boyd, Jr. 2022-05-17