0001437749-19-010306.txt : 20190517 0001437749-19-010306.hdr.sgml : 20190517 20190517092610 ACCESSION NUMBER: 0001437749-19-010306 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20190515 FILED AS OF DATE: 20190517 DATE AS OF CHANGE: 20190517 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Sansone Christopher R. CENTRAL INDEX KEY: 0001519525 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-35020 FILM NUMBER: 19834334 MAIL ADDRESS: STREET 1: C/O SANSONE ADVISORS, LLC STREET 2: 151 BODMAN PLACE, SUITE 100 CITY: RED BANK STATE: NJ ZIP: 07701 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 rdgdoc.xml FORM 4 X0306 4 2019-05-15 0001337013 InfuSystem Holdings, Inc INFU 0001519525 Sansone Christopher R. C/O INFUSYSTEM HOLDINGS, INC. 31700 RESEARCH PARK DRIVE MADISON HEIGHTS MI 48071 1 Stock Option (Right to Buy) 4.70 2019-05-15 4 A 0 25000 0 A 2024-05-15 Common Stock 25000 25000 D The option, representing the right to purchase a total of 25,000 shares of InfuSystem Holdings, Inc. common stock, vests in twelve equal monthly installments beginning on June 15, 2019. /s/ Jeanie Latz, Attorney-in-Fact for Christopher R. Sansone 2019-05-17