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