0001014108-21-000180.txt : 20211012 0001014108-21-000180.hdr.sgml : 20211012 20211012182529 ACCESSION NUMBER: 0001014108-21-000180 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20211008 FILED AS OF DATE: 20211012 DATE AS OF CHANGE: 20211012 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Shuda Scott CENTRAL INDEX KEY: 0001486636 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-35020 FILM NUMBER: 211319624 MAIL ADDRESS: STREET 1: 402 RAILROAD AVENUE, SUITE 201 CITY: DANVILLE STATE: CA ZIP: 94526 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 2021-10-08 0 0001337013 InfuSystem Holdings, Inc INFU 0001486636 Shuda Scott C/O INFUSYSTEM HOLDINGS, INC. 3851 WEST HAMLIN ROAD ROCHESTER HILLS MI 48309 1 0 0 0 Common Stock 2021-10-08 4 M 0 25000 1.98 A 65494 D Stock Option (right to buy) 1.98 2021-10-08 4 M 0 25000 0 D 2018-09-07 2022-09-18 Common Stock 25000 130000 D /s/ Kevin R. Whitman, Attorney-in-Fact for Scott Shuda 2021-10-12