0001628280-23-019115.txt : 20230519 0001628280-23-019115.hdr.sgml : 20230519 20230519170003 ACCESSION NUMBER: 0001628280-23-019115 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20230518 FILED AS OF DATE: 20230519 DATE AS OF CHANGE: 20230519 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: GENDRON PAUL ANDREW CENTRAL INDEX KEY: 0001769450 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-35020 FILM NUMBER: 23941228 MAIL ADDRESS: STREET 1: 740 BANDIT TRAIL CITY: KELLER STATE: TX ZIP: 76248 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_168452999025397.xml FORM 4 X0407 4 2023-05-18 0 0001337013 InfuSystem Holdings, Inc INFU 0001769450 GENDRON PAUL ANDREW C/O INFUSYSTEM HOLDINGS, INC. 3851 WEST HAMLIN ROAD ROCHESTER HILLS MI 48309 1 0 0 0 0 Common Stock 60000 D Stock Options (right to buy) 9.18 2023-05-18 4 A 0 24424 0 A 2024-05-18 2033-05-18 Common Stock 24424.0 24424 D The option, representing the right to purchase a total of 24,424 shares of InfuSystem Holdings, Inc. common stock, vests on May 18, 2024. /s/ Kevin Whitman, Attorney-in-Fact for Paul A. Gendron 2023-05-19