0001014108-20-000102.txt : 20200825 0001014108-20-000102.hdr.sgml : 20200825 20200825155004 ACCESSION NUMBER: 0001014108-20-000102 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20200824 FILED AS OF DATE: 20200825 DATE AS OF CHANGE: 20200825 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Dilorio Richard CENTRAL INDEX KEY: 0001706994 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-35020 FILM NUMBER: 201132237 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 2020-08-24 0 0001337013 InfuSystem Holdings, Inc INFU 0001706994 Dilorio Richard 3851 WEST HAMLIN ROAD ROCHESTER HILLS MI 48309 1 1 0 0 President & CEO Common Stock 2020-08-24 4 A 0 20000 0 A 261737 D Restricted Stock Units 2020-08-24 4 A 0 180000 0 A 2023-08-24 Common Stock 180000 180000 D Service-based restricted stock award which vests 10,000 restricted stock units on the first anniversary of the date of grant, and the remaining 10,000 restricted stock units on the second anniversary of the date of grant. Restricted stock units convert into common stock on a one-for-one basis. Performance-based restricted stock award which will vest on the date which the Company stock price has achieved an applicable closing price for 10 consecutive trading days during a performance period beginning on the date of the grant and ending on the third anniversary of the date of grant. The award is divided into three equal tranches of 60,000 shares each having a different applicable closing price of $18.00, $20.00 and $22.00, respectively. /s/Kevin Whitman, Attorney-in-Fact for Richard Dilorio 2020-08-25