0001014108-17-000196.txt : 20171127
0001014108-17-000196.hdr.sgml : 20171127
20171127175005
ACCESSION NUMBER: 0001014108-17-000196
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20171122
FILED AS OF DATE: 20171127
DATE AS OF CHANGE: 20171127
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Sansone Christopher R.
CENTRAL INDEX KEY: 0001519525
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-35020
FILM NUMBER: 171223751
MAIL ADDRESS:
STREET 1: C/O SANSONE ADVISORS, LLC
STREET 2: 151 BODMAN PLACE, SUITE 100
CITY: RED BANK
STATE: NJ
ZIP: 07701
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
2017-11-22
0
0001337013
InfuSystem Holdings, Inc
INFU
0001519525
Sansone Christopher R.
C/O INFUSYSTEM HOLDINGS, INC.
31700 RESEARCH PARK DRIVE
MADISON HEIGHTS
MI
48071
1
0
0
0
Common Stock
2017-11-22
4
P
0
3998
2.155
A
1275404
D
Common Stock
2017-11-22
4
P
0
1000
2.155
A
267486
D
Common Stock
1483548
I
See
Common Stock
1483548
I
See
Common Stock
1483548
I
See
The reported securities are directly owned by Sansone Partners, L.P., a Delaware limited partnership.
The reported securities are directly owned by Sansone Partners (QP), L.P., a Delaware limited partnership.
The reported securities are directly owned by (i) Sansone Partners, L.P., a Delaware limited partnership (the "3c1 Partnership"), and (ii) Sansone Partners (QP), L.P., a Delaware limited partnership (the "3c7 Partnership", and together with the 3c1 Partnership, the "Partnerships"), and may be deemed to be indirectly beneficially owned by Sansone Advisors, LLC, a Delaware limited liability company, as the investment manager of Partnerships (the "Investment Manager"), and by Sansone Capital Management, LLC, a Delaware limited liability company, as general partner of the Partnerships (the "General Partner"). The reported securities may also be deemed to be indirectly beneficially owned by Christopher Sansone as the managing member of the Investment Manager and the General Partner. The Reporting Persons disclaim beneficial ownership of the reported securities except to the extent of his or its pecuniary interest therein.
/s/Trent N. Smith, Attorney-in-Fact for Christopher R. Sansone
2017-11-27