0001445866-17-001311.txt : 20170908
0001445866-17-001311.hdr.sgml : 20170908
20170908195315
ACCESSION NUMBER: 0001445866-17-001311
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20170908
FILED AS OF DATE: 20170908
DATE AS OF CHANGE: 20170908
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: 171077666
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: 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: 171077668
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: 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: 171077667
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: 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: 171077669
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: 171077670
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
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
form4.xml
OWNERSHIP DOCUMENT
X0306
4
2017-09-08
0
0001337013
InfuSystem Holdings, Inc
INFU
0001601397
Meridian OHC Partners, LP
425 WEED STREET
NEW CANAAN
CT
06840
1
0
1
0
0001601536
Meridian TSV II, LP
425 WEED STREET
NEW CANAAN
CT
06840
1
0
1
0
0001603326
TSV Investment Partners, LLC
425 WEED STREET
NEW CANAAN
CT
06840
1
0
1
0
0001460781
BlueLine Capital Partners II, L.P.
3480 BUSKIRK AVENUE
SUITE 214
PLEASANT HILL
CA
94523
1
0
1
0
0001311443
BlueLine Partners, L.L.C.
3480 BUSKIRK AVENUE
SUITE 214
PLEASANT HILL
CA
94523
1
0
1
0
Common Stock
2017-09-08
4
J
0
225000
2.0
A
3007570
D
These securities are owned by Meridian TSV II, LP., and were acquired coincident to a subscription by a new limited partner to such entity. As described in the Schedule 13D filing made on February 12, 2016 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
2017-09-08