0001014108-21-000098.txt : 20210416 0001014108-21-000098.hdr.sgml : 20210416 20210416154706 ACCESSION NUMBER: 0001014108-21-000098 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20210414 FILED AS OF DATE: 20210416 DATE AS OF CHANGE: 20210416 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: 21831383 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 2021-04-14 0 0001337013 InfuSystem Holdings, Inc INFU 0001706994 Dilorio Richard 3851 WEST HAMLIN ROAD ROCHESTER HILL MI 48309 1 1 0 0 President and CEO Common Stock 2021-04-14 4 M 0 60000 0 A 266367 D Common Stock 2021-04-14 4 F 0 26610 21.63 D 239757 D Restricted Stock Units 2021-04-14 4 M 0 60000 0 D 2023-08-24 Common Stock 60000 60000 D Vesting of second tranche of performance-based restricted stock award granted on August 24, 2020. This total includes 1,813 shares acquired recently through the Company's Employee Stock Purchase Plan. Represents the withholding of the Issuer's common stock for the tax liability associated with the vesting and settlement of a portion of the restricted stock units granted on August 24, 2020. Restricted stock units convert into common stock on a one-for-one basis. Performance-based restricted stock award which will vest on the date which the Company stock price has achieved an applicable closing price for 10 consecutive trading days during a performance period beginning on the date of the grant and ending on the third anniversary of the date of grant. /s/Kevin Whitman, Attorney-in-Fact for Richard Dilorio 2021-04-16