0001628280-22-025170.txt : 20220919 0001628280-22-025170.hdr.sgml : 20220919 20220919194818 ACCESSION NUMBER: 0001628280-22-025170 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20220916 FILED AS OF DATE: 20220919 DATE AS OF CHANGE: 20220919 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Shuda Scott CENTRAL INDEX KEY: 0001486636 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-35020 FILM NUMBER: 221251839 MAIL ADDRESS: STREET 1: 402 RAILROAD AVENUE, SUITE 201 CITY: DANVILLE STATE: CA ZIP: 94526 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_166363128387331.xml FORM 4 X0306 4 2022-09-16 0 0001337013 InfuSystem Holdings, Inc INFU 0001486636 Shuda Scott C/O INFUSYSTEM HOLDINGS, INC. 3851 WEST HAMLIN ROAD ROCHESTER HILLS MI 48309 1 0 0 0 Common Stock 2022-09-16 4 M 0 25000 3.18 A 90494 D Stock Option (right to buy) 3.18 2022-09-16 4 M 0 25000 0 D 2023-08-23 Common Stock 25000.0 0 D The option, representing the right to purchase 25,000 shares of InfuSystem Holdings, Inc. common stock, vests in twelve monthly installments beginning September 23, 2018. /s/ Kevin R. Whitman, Attorney-in-Fact for Scott Shuda 2022-09-19