0001014108-21-000121.txt : 20210521 0001014108-21-000121.hdr.sgml : 20210521 20210521120943 ACCESSION NUMBER: 0001014108-21-000121 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20210518 FILED AS OF DATE: 20210521 DATE AS OF CHANGE: 20210521 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: RUIZ THOMAS MARK CENTRAL INDEX KEY: 0001768484 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-35020 FILM NUMBER: 21947755 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: 3851 WEST HAMLIN ROAD CITY: ROCHESTER HILLS STATE: MI ZIP: 48309 BUSINESS PHONE: (248) 291-1210 MAIL ADDRESS: STREET 1: 3851 WEST HAMLIN ROAD CITY: ROCHESTER HILLS STATE: MI ZIP: 48309 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 2021-05-18 0 0001337013 InfuSystem Holdings, Inc INFU 0001768484 RUIZ THOMAS MARK 31700 RESEARCH PARK DRIVE MADISON HEIGHTS MI 48071 0 1 0 0 Chief Commercial Officer Common Stock 2021-05-18 4 P 0 0 0 A 6524 D Stock Option (right to buy) 19.5 2021-05-18 4 A 0 9134 0 A 2031-05-18 Common Stock 9134 9134 D Restricted Stock Units 2021-05-18 4 A 0 6229 0 A Common Stock 6229 6229 D Restricted Stock Units 2021-05-18 4 A 0 2821 0 A Common Stock 2821 2821 D The option, representing the right to purchase a total of 9,134 shares of InfuSystem Holdings, Inc. common stock, vests in three equal annual installments beginning May 18, 2022. Restricted stock units convert into common stock on a one-for-one basis. These restricted stock units will cliff vest on May 18, 2024. These restricted stock units will cliff vest on May 18, 2022. Kevin Whitman 2021-05-21