0001014108-22-000010.txt : 20220104
0001014108-22-000010.hdr.sgml : 20220104
20220104211613
ACCESSION NUMBER: 0001014108-22-000010
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20211230
FILED AS OF DATE: 20220104
DATE AS OF CHANGE: 20220104
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Sheehan Jeannine
CENTRAL INDEX KEY: 0001775188
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-35020
FILM NUMBER: 22508879
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
2021-12-30
0
0001337013
InfuSystem Holdings, Inc
INFU
0001775188
Sheehan Jeannine
3851 WEST HAMLIN ROAD
ROCHESTER HILL
MI
48309
0
1
0
0
Chief Administrative Officer
Common Stock
2021-12-30
4
M
0
1000
4.48
A
18607
D
Common Stock
2021-12-30
4
S
0
1000
17
D
17607
D
Common Stock
2021-12-31
4
M
0
6943
4.48
A
24550
D
Common Stock
2021-12-31
4
S
0
6943
17.01
D
17607
D
Common Stock
345
I
By Children
Stock Option (right to buy)
4.48
2021-12-30
4
M
0
1000
0
D
2020-04-22
2024-04-22
Common Stock
1000
41539
D
Stock Option (right to buy)
4.48
2021-12-31
4
M
0
6943
0
D
2020-04-22
2024-04-22
Common Stock
6943
34596
D
The price reported in Column 4 is a weighted average price. The shares reported herein were sold in multiple transactions. The reporting person undertakes to provide to the Issuer, any security holder of the Issuer, or the staff of the Securities and Exchange Commission, upon request, full information regarding the number of shares sold at each separate price.
The reporting person disclaims beneficial ownership of these securities, and this report shall not be deemed an admission that the reporting person is the beneficial owner of such securities for purposes of Section 16 or for any other purpose.
/s/ Kevin Whitman, Attorney-in-Fact for Jeannine Sheehan
2022-01-04