0001014108-21-000026.txt : 20210211
0001014108-21-000026.hdr.sgml : 20210211
20210211204203
ACCESSION NUMBER: 0001014108-21-000026
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20210209
FILED AS OF DATE: 20210211
DATE AS OF CHANGE: 20210211
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: 21622094
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
2021-02-09
0
0001337013
InfuSystem Holdings, Inc
INFU
0001706994
Dilorio Richard
3851 WEST HAMLIN ROAD
ROCHESTER HILLS
MI
48309
0
1
0
0
President and CEO
Common Stock
2021-02-09
4
A
0
8034
0
A
204554
D
The reported shares were issued as part of the issuer's Short Term Incentive ("STI") plan relating to the issuer's 2020 performance. The issuer's board of directors decided that a portion of the award determined payable to the issuer's executive team would be payable in the form of fully-vested shares of the issuer's common stock. Such shares are issued under the issuer's 2014 Equity Plan.
/s/Kevin Whitman, Attorney-in-Fact for Richard Dilorio
2021-02-11