0001628280-23-019118.txt : 20230519 0001628280-23-019118.hdr.sgml : 20230519 20230519170150 ACCESSION NUMBER: 0001628280-23-019118 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20230517 FILED AS OF DATE: 20230519 DATE AS OF CHANGE: 20230519 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Chupa Addam CENTRAL INDEX KEY: 0001953233 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-35020 FILM NUMBER: 23941300 MAIL ADDRESS: STREET 1: 3851 WEST HAMLIN ROAD CITY: ROCHESTER HILLS STATE: MI ZIP: 48309 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_168453008208079.xml FORM 4 X0407 4 2023-05-17 0 0001337013 InfuSystem Holdings, Inc INFU 0001953233 Chupa Addam C/O INFUSYSTEM HOLDINGS, INC. 3851 WEST HAMLIN ROAD ROCHESTER HILLS MI 48309 0 1 0 0 Executive VP and CIO 0 Common Stock 2023-05-17 4 M 0 9744 0 A 20780 D Common Stock 2023-05-17 4 F 0 3799 9.18 D 16981 D Restricted Stock Units 2023-05-17 4 M 0 9744 0 D 2023-05-17 2023-05-17 Common Stock 9744.0 0 D These restricted stock units vested on May 17, 2023. This total includes an additional 974 shares acquired recently through the Company's Employee Stock Purchase Plan Represents the withholding of the Issuer's common stock for the tax liability associated with the vesting and settlement of the common stock issued on May 17, 2023 Restricted stock units convert into common stock on a one-for-one basis. /s/ Kevin Whitman, Attorney-in-Fact for Addam Chupa 2023-05-19