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