0001014108-21-000028.txt : 20210211 0001014108-21-000028.hdr.sgml : 20210211 20210211205212 ACCESSION NUMBER: 0001014108-21-000028 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: Lachance Carrie CENTRAL INDEX KEY: 0001790024 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-35020 FILM NUMBER: 21622114 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 0001790024 Lachance Carrie 3851 WEST HAMLIN ROAD ROCHESTER HILLS MI 48309 0 1 0 0 Executive VP and COO Common Stock 2021-02-09 4 A 0 4017 0 A 84956 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. This total includes an additional 1,146 shares acquired recently through the Company's Employee Stock Purchase Plan. /s/Kevin Whitman, Attorney-in-Fact for Carrie Lachance 2021-02-11