0001628280-23-019362.txt : 20230522 0001628280-23-019362.hdr.sgml : 20230522 20230522202757 ACCESSION NUMBER: 0001628280-23-019362 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20230518 FILED AS OF DATE: 20230522 DATE AS OF CHANGE: 20230522 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Lachance Carrie CENTRAL INDEX KEY: 0001790024 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-35020 FILM NUMBER: 23946272 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_168480166534363.xml FORM 4 X0407 4 2023-05-18 0 0001337013 InfuSystem Holdings, Inc INFU 0001790024 Lachance Carrie C/O INFUSYSTEM HOLDINGS, INC. 3851 WEST HAMLIN ROAD ROCHESTER HILLS MI 48309 1 1 0 0 President and COO 0 Common Stock 131095 D Stock Options (right to buy) 9.18 2023-05-18 4 A 0 60084 0 A 2033-05-18 Common Stock 60084.0 60084 D Restricted Stock Units 2023-05-18 4 A 0 8932 0 A 2026-05-18 Common Stock 8932.0 8932 D This total includes an additional 3,156 shares acquired recently through the Company's Employee Stock Purchase Plan The option, representing the right to purchase a total of 60,084 shares of InfuSystem Holdings, Inc. common stock, vests in three equal annual installments beginning May 18, 2024. Restricted stock units convert into common stock on a one-for-one basis. These restricted stock units will fully vest on May 18, 2026. /s/ Kevin Whitman, Attorney-in-Fact for Carrie Lachance 2023-05-22