0001445866-15-001212.txt : 20151103 0001445866-15-001212.hdr.sgml : 20151103 20151103171308 ACCESSION NUMBER: 0001445866-15-001212 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20151029 FILED AS OF DATE: 20151103 DATE AS OF CHANGE: 20151103 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: BlueLine Partners, L.L.C. CENTRAL INDEX KEY: 0001311443 FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-35020 FILM NUMBER: 151194563 BUSINESS ADDRESS: STREET 1: 3480 BUSKIRK AVENUE STREET 2: SUITE 214 CITY: PLEASANT HILL STATE: CA ZIP: 94523 BUSINESS PHONE: 925-648-2085 MAIL ADDRESS: STREET 1: 3480 BUSKIRK AVENUE STREET 2: SUITE 214 CITY: PLEASANT HILL STATE: CA ZIP: 94523 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: BlueLine Capital Partners II, L.P. CENTRAL INDEX KEY: 0001460781 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-35020 FILM NUMBER: 151194564 BUSINESS ADDRESS: STREET 1: 3480 BUSKIRK AVENUE STREET 2: SUITE 214 CITY: PLEASANT HILL STATE: CA ZIP: 94523 BUSINESS PHONE: 925-236-9790 MAIL ADDRESS: STREET 1: 3480 BUSKIRK AVENUE STREET 2: SUITE 214 CITY: PLEASANT HILL STATE: CA ZIP: 94523 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: TSV Investment Partners, LLC CENTRAL INDEX KEY: 0001603326 STATE OF INCORPORATION: CT FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-35020 FILM NUMBER: 151194565 BUSINESS ADDRESS: STREET 1: 405 WEED STREET CITY: NEW CANAAN STATE: CT ZIP: 06840 BUSINESS PHONE: 203-643-9300 MAIL ADDRESS: STREET 1: 405 WEED STREET CITY: NEW CANAAN STATE: CT ZIP: 06840 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Meridian TSV II, LP CENTRAL INDEX KEY: 0001601536 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-35020 FILM NUMBER: 151194566 BUSINESS ADDRESS: STREET 1: 405 WEED STREET CITY: NEW CANAAN STATE: CT ZIP: 06840 BUSINESS PHONE: 203-643-9300 MAIL ADDRESS: STREET 1: 405 WEED STREET CITY: NEW CANAAN STATE: CT ZIP: 06840 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Meridian OHC Partners, LP CENTRAL INDEX KEY: 0001601397 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-35020 FILM NUMBER: 151194567 BUSINESS ADDRESS: STREET 1: 405 WEED STREET CITY: NEW CANAAN STATE: CT ZIP: 06840 BUSINESS PHONE: 203-643-9300 MAIL ADDRESS: STREET 1: 405 WEED STREET CITY: NEW CANAAN STATE: CT ZIP: 06840 4 1 form4.xml OWNERSHIP DOCUMENT X0306 4 2015-10-29 0 0001337013 InfuSystem Holdings, Inc INFU 0001601397 Meridian OHC Partners, LP 425 WEED STREET NEW CANAAN CT 06840 0 0 1 0 0001601536 Meridian TSV II, LP 425 WEED STREET NEW CANAAN CT 06840 0 0 1 0 0001603326 TSV Investment Partners, LLC 425 WEED STREET NEW CANAAN CT 06840 0 0 1 0 0001460781 BlueLine Capital Partners II, L.P. 3480 BUSKIRK AVENUE SUITE 214 PLEASANT HILL CA 94523 0 0 1 0 0001311443 BlueLine Partners, L.L.C. 3480 BUSKIRK AVENUE SUITE 214 PLEASANT HILL CA 94523 0 0 1 0 Common Stock 2015-10-29 4 P 0 2666 2.75 A 2417467 D Common Stock 2015-10-29 4 P 0 34 2.74 A 2417501 D Common Stock 2015-10-30 4 P 0 300 2.72 A 2417801 D Common Stock 2015-11-03 4 P 0 270 2.70 A 2418071 D Common Stock 2015-11-03 4 P 0 4419 2.75 A 2422290 D These securities are owned by Meridian OHC Partners, LP. As described in the Amendment #1 to Schedule 13G filing made on February 6, 2015 with respect to the Common Stock owned by Meridian OHC Partners, LP, Meridian TSV II, LP, TSV Investment Partners, LLC, BlueLine Capital Partners II, L.P. and BlueLine Partners, L.L.C., the Reporting Entities may have been deemed to be a "group" under Section 13(d) of the Securities Exchange Act and accordingly each Reporting Person may have been deemed to have beneficial ownership of 10% or more of the Common Stock. /s/ Scott A. Shuda 2015-11-03