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