0001628280-24-024598.txt : 20240521 0001628280-24-024598.hdr.sgml : 20240521 20240521181719 ACCESSION NUMBER: 0001628280-24-024598 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: Funke Jerod CENTRAL INDEX KEY: 0001998115 ORGANIZATION NAME: FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-35020 FILM NUMBER: 24971117 MAIL ADDRESS: STREET 1: 3851 WEST HAMLIN RD 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] 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_1716329826.xml FORM 4 X0508 4 2024-05-17 0 0001337013 InfuSystem Holdings, Inc INFU 0001998115 Funke Jerod C/O INFUSYSTEM HOLDINGS, INC. 3851 WEST HAMLIN ROAD ROCHESTER HILLS MI 48309 0 1 0 0 EVP-Chief HR Officer 0 Common Stock 2024-05-20 4 P 0 1000 6.3875 A 1000 D Restricted Stock Units 0 2024-05-17 4 A 0 14146 0 A 2027-05-17 2027-05-17 Common Stock 14146 14146 D Stock Option (right to buy) 6.34 2024-05-17 4 A 0 64010 0 A 2034-05-17 Common Stock 64010 64010 D The price reported in Column 4 is a weighted average price. These shares reported herein were purchased in multiple transactions. The reporting person undertakes to provide to the Issuer, and security holder of the Issuer, or the staff of the Securities and Exchange Commission, upon request, full information regarding the number of shares purchased at each separate price. Restricted stock units convert into common stock on a one-for-one basis. The option, representing the right to purchase a total of 64,010 shares of InfuSystem Holdings, Inc. common stock, vests in four equal annual installments beginning May 17, 2025. /s/ Kevin Whitman, Attorney-in-Fact for Jerod Funke 2024-05-21