0001014108-21-000062.txt : 20210303
0001014108-21-000062.hdr.sgml : 20210303
20210303183109
ACCESSION NUMBER: 0001014108-21-000062
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20210301
FILED AS OF DATE: 20210303
DATE AS OF CHANGE: 20210303
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: 21711233
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
2021-03-01
0
0001337013
InfuSystem Holdings, Inc
INFU
0001790024
Lachance Carrie
3851 WEST HAMLIN ROAD
ROCHESTER HILLS
MI
48309
0
1
0
0
President and COO
Restricted Stock Units
2021-03-01
4
A
0
50000
0
A
Common Stock
50000
50000
D
Restricted stock units convert into common stock on a one-for-one basis.
These restricted stock units will cliff vest on March 1, 2024.
/s/Kevin Whitman, Attorney-in-Fact for Carrie Lachance
2021-03-03