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