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