0001628280-23-019116.txt : 20230519 0001628280-23-019116.hdr.sgml : 20230519 20230519170026 ACCESSION NUMBER: 0001628280-23-019116 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: Shuda Scott CENTRAL INDEX KEY: 0001486636 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-35020 FILM NUMBER: 23941243 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_168453000961937.xml FORM 4 X0407 4 2023-05-18 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 0 Common Stock 340624 I Footnote 1 Common Stock 90494 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 Mr. Shuda serves as Managing Director of (i) TSV Investment Partners, LLC, which is the sole general partner of Meridian OHC Partners, LP ("Meridian") and (ii) BlueLine Partners, LLC, which is the sole general partner of BlueLine Capital Partners II, LP ("BlueLine"). Accordingly, Mr. Shuda holds voting and dispositive power over the Common Stock held by Meridian and BlueLine. Mr. Shuda disclaims beneficial ownership for purposes of Rule 13d-3 with respect to the Common Stock held by Meridian and BlueLine. 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 R. Whitman, Attorney-in-Fact for Scott Shuda 2023-05-19