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