0001014108-21-000031.txt : 20210211
0001014108-21-000031.hdr.sgml : 20210211
20210211211519
ACCESSION NUMBER: 0001014108-21-000031
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: Whitman Kevin
CENTRAL INDEX KEY: 0001768114
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-35020
FILM NUMBER: 21622177
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
0001768114
Whitman Kevin
3851 WEST HAMLIN ROAD
ROCHESTER HILLS
MI
48309
0
1
0
0
VP and Corporate Controller
Restricted Stock Units
2021-02-09
4
A
0
1500
0
A
Common Stock
1500
1500
D
Stock Option (right to buy)
18.44
2021-02-09
4
A
0
1500
0
A
2031-02-09
Common Stock
1500
1500
D
Restricted stock units convert into common stock on a one-for-one basis.
These restricted stock units will fully vest on February 9, 2024.
The stock option vests 33% per year on the anniversary date of the grant beginning February 9, 2022.
/s/Kevin Whitman
2021-02-11