0001437749-19-002934.txt : 20190220 0001437749-19-002934.hdr.sgml : 20190220 20190220151441 ACCESSION NUMBER: 0001437749-19-002934 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20190212 FILED AS OF DATE: 20190220 DATE AS OF CHANGE: 20190220 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: RUIZ THOMAS MARK CENTRAL INDEX KEY: 0001768484 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-35020 FILM NUMBER: 19618050 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: 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 3 1 rdgdoc.xml FORM3 X0206 3 2019-02-12 0 0001337013 InfuSystem Holdings, Inc INFU 0001768484 RUIZ THOMAS MARK 31700 RESEARCH PARK DRIVE MADISON HEIGHTS MI 48071 1 VP OF SALES AND MARKETING Common Stock 5337 D Stock Option (Right to Buy) 2.6900 2017-07-31 2024-12-08 Common Stock 50000 D Stock Option (Right to Buy) 2.7600 2026-08-18 Common Stock 40000 D Stock Option (Right to Buy) 2.1500 2027-03-15 Common Stock 25000 D Stock Option (Right to Buy) 1.9800 2022-09-06 Common Stock 25000 D Stock Option (Right to Buy) 3.3600 2023-07-19 Common Stock 25000 D Restricted Stock Units 2019-03-11 2019-03-12 Common Stock 2083 D The option, representing the right to purchase a total of 40,000 shares, became exercisable in 36 equal monthly installments following the August 18, 2016 date of grant. The option, representing the right to purchase a total of 25,000 shares, became exercisable in 36 equal monthly installments following the March 16, 2017 date of grant. Stock option vests 33% per year on anniversary date starting September 7, 2018 Stock option vests 33% per year on anniversary date starting July 19, 2019 Restricted stock units convert into common stock on a one-for-one basis. The reporting person was awarded restricted stock units on March 11, 2015, which vest in one remaining annual installment on March 11th of 2019. Settlement of the underlying shares of common stock will occur on vesting date, assuming continued employment through the applicable vesting date. /s/ Thomas M. Ruiz 2019-02-20