0001181431-13-001710.txt : 20130104 0001181431-13-001710.hdr.sgml : 20130104 20130104163133 ACCESSION NUMBER: 0001181431-13-001710 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20130102 FILED AS OF DATE: 20130104 DATE AS OF CHANGE: 20130104 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Skonieczny Janet CENTRAL INDEX KEY: 0001418854 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-35020 FILM NUMBER: 13512161 MAIL ADDRESS: STREET 1: C/O INFUSYSTEM HOLDINGS, INC. STREET 2: 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: 31700 RESEARCH PARK DRIVE CITY: MADISON HEIGHTS STATE: MI ZIP: 48071 BUSINESS PHONE: (248) 291-1210 MAIL ADDRESS: STREET 1: 31700 RESEARCH PARK DRIVE CITY: MADISON HEIGHTS STATE: MI ZIP: 48071 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 rrd365873.xml X0306 4 2013-01-02 0 0001337013 InfuSystem Holdings, Inc INFU 0001418854 Skonieczny Janet C/O INFUSYSTEM HOLDINGS, INC. 31700 RESEARCH PARK DRIVE MADISON HEIGHTS MI 48071 0 1 0 0 COO Employee Stock Option (right to buy) 1.51 2013-01-02 4 A 0 110000 A 2023-01-02 Common Stock 110000 110000 D On January 2, 2013, in connection with her promotion to Chief Operating Officer the issuer granted the reporting person options to purchase 110,000 shares of common stock under the InfuSystem Holdings, Inc. 2007 Stock Incentive Plan. The price represents the closing price of the issuer's common stock on the date of grant. The options vest ratably on the next three anniversaries of the date of grant. /s/ Janet Skonieczny 2013-01-04