0001014108-20-000066.txt : 20200522
0001014108-20-000066.hdr.sgml : 20200522
20200522183903
ACCESSION NUMBER: 0001014108-20-000066
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20200520
FILED AS OF DATE: 20200522
DATE AS OF CHANGE: 20200522
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Lachance Carrie
CENTRAL INDEX KEY: 0001790024
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-35020
FILM NUMBER: 20907529
MAIL ADDRESS:
STREET 1: 31700 RESEARCH PARK DRIVE
CITY: MADISON HEIGHTS
STATE: MI
ZIP: 48071
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
2020-05-20
0
0001337013
InfuSystem Holdings, Inc
INFU
0001790024
Lachance Carrie
3851 WEST HAMLIN ROAD
ROCHESTER HILLS
MI
48309
0
1
0
0
Executive VP and COO
Common Stock
77793
D
Stock Option (right to buy)
11.07
2020-05-20
4
A
0
20000
0
A
2030-05-20
Common Stock
20000
20000
D
This total includes an additional 2,507 shares acquired recently through the Company's Employee Stock Purchase Plan.
The stock option was issued with an exercise price equal to the Fair Value as defined by the 2014 Equity Plan, which is computed as the average closing price of the Company's common stock reported on the NYSE American LLC for the five (5) most recent trading days prior to the date of grant.
The stock option vests 33% per year on the anniversary date of the grant beginning May 20, 2021.
/s/ Kevin Whitman, Attorney-in-Fact for Carrie Lachance
2020-05-22