0001628280-22-014660.txt : 20220517
0001628280-22-014660.hdr.sgml : 20220517
20220517171101
ACCESSION NUMBER: 0001628280-22-014660
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20220517
FILED AS OF DATE: 20220517
DATE AS OF CHANGE: 20220517
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Lachance Carrie
CENTRAL INDEX KEY: 0001790024
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-35020
FILM NUMBER: 22935731
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
wf-form4_165282182948302.xml
FORM 4
X0306
4
2022-05-17
0
0001337013
InfuSystem Holdings, Inc
INFU
0001790024
Lachance Carrie
C/O INFUSYSTEM HOLDINGS, INC.
3851 WEST HAMLIN ROAD
ROCHESTER HILLS
MI
48309
1
1
0
0
President and COO
Common Stock
98512
D
Stock Option (right to buy)
8.58
2022-05-17
4
A
0
25993
0
A
2032-05-17
Common Stock
25993.0
25993
D
Restricted Stock Units
2022-05-17
4
A
0
17727
0
A
Common Stock
17727.0
17727
D
This total includes an additional 1,858 shares acquired recently through the Company's Employee Stock Purchase Plan
The stock option was issued with an exercise price equal to the Fair Value as defined by the 2021 Equity Plan, which is computed as the closing price of the Company's common stock reported on the NYSE American LLC on the date of grant.
The option, representing the right to purchase a total of 25,993 shares of InfuSystem Holdings, Inc. common stock, vests in three equal annual installments beginning May 17, 2023.
Restricted stock units convert into common stock on a one-for-one basis.
These restricted stock units will cliff vest on May 17, 2025.
/s/ Kevin Whitman, Attorney-in-Fact for Carrie Lachance
2022-05-17