0001628280-22-014661.txt : 20220517 0001628280-22-014661.hdr.sgml : 20220517 20220517171320 ACCESSION NUMBER: 0001628280-22-014661 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: Sheehan Jeannine CENTRAL INDEX KEY: 0001775188 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-35020 FILM NUMBER: 22935771 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_165282187157291.xml FORM 4 X0306 4 2022-05-17 0 0001337013 InfuSystem Holdings, Inc INFU 0001775188 Sheehan Jeannine C/O INFUSYSTEM HOLDINGS, INC. 3851 WEST HAMLIN ROAD ROCHESTER HILLS MI 48309 0 1 0 0 Chief Administrative Officer Common Stock 19152 D Common Stock 345 I By children Stock Option (right to buy) 8.58 2022-05-17 4 A 0 18995 0 A 2032-05-17 Common Stock 18995.0 18995 D Restricted Stock Units 2022-05-17 4 A 0 12955 0 A Common Stock 12955.0 12955 D This total includes an additional 1,545 shares acquired recently through the Company's Employee Stock Purchase Plan The reporting person disclaims beneficial ownership of these securities, and this report shall not be deemed an admission that the reporting person is the beneficial owner of such securities for purposes of Section 16 or for any other purpose. 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 18,995 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 Jeannine Sheehan 2022-05-17