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