0001014108-20-000069.txt : 20200522 0001014108-20-000069.hdr.sgml : 20200522 20200522191237 ACCESSION NUMBER: 0001014108-20-000069 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: RUIZ THOMAS MARK CENTRAL INDEX KEY: 0001768484 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-35020 FILM NUMBER: 20907579 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 0001768484 RUIZ THOMAS MARK 3851 WEST HAMLIN ROAD ROCHESTER HILLS MI 48309 0 1 0 0 Chief Commercial Officer Common Stock 11512 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 2,462 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 Thomas Ruiz 2020-05-22