0001628280-24-024589.txt : 20240521 0001628280-24-024589.hdr.sgml : 20240521 20240521181202 ACCESSION NUMBER: 0001628280-24-024589 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20240517 FILED AS OF DATE: 20240521 DATE AS OF CHANGE: 20240521 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Shuda Scott CENTRAL INDEX KEY: 0001486636 ORGANIZATION NAME: FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-35020 FILM NUMBER: 24971098 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] ORGANIZATION NAME: 08 Industrial Applications and Services 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 wk-form4_1716329513.xml FORM 4 X0508 4 2024-05-17 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 101994 D Stock Option (right to buy) 6.34 2024-05-17 4 A 0 35685 0 A 2025-05-17 2034-05-17 Common Stock 35685 35685 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 ("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 35,685 shares of InfuSystem Holdings, Inc. common stock, vests on May 17, 2025. /s/ Kevin R. Whitman, Attorney-in-Fact for Scott Shuda 2024-05-21