0001014108-21-000225.txt : 20211230
0001014108-21-000225.hdr.sgml : 20211230
20211230175328
ACCESSION NUMBER: 0001014108-21-000225
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20211229
FILED AS OF DATE: 20211230
DATE AS OF CHANGE: 20211230
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: 211533878
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
2021-12-29
0
0001337013
InfuSystem Holdings, Inc
INFU
0001768484
RUIZ THOMAS MARK
3851 WEST HAMLIN ROAD
ROCHESTER HILL
MI
48309
0
1
0
0
Chief Commercial Officer
Common Stock
2021-12-29
4
S
0
76
17
D
16980
D
/s/Kevin Whitman, Attorney-in-Fact for Thomas Ruiz
2021-12-30