0001628280-24-024603.txt : 20240521
0001628280-24-024603.hdr.sgml : 20240521
20240521181954
ACCESSION NUMBER: 0001628280-24-024603
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: Lachance Carrie
CENTRAL INDEX KEY: 0001790024
ORGANIZATION NAME:
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-35020
FILM NUMBER: 24971124
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]
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_1716329979.xml
FORM 4
X0508
4
2024-05-17
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
175426
D
Common Stock
2024-05-17
4
A
0
5052
0
A
180478
D
Common Stock
2024-05-17
4
F
0
1988
6.44
D
178490
D
Common Stock
2024-05-18
4
M
0
8077
0
A
186567
D
Common Stock
2024-05-18
4
F
0
3179
6.44
D
183388
D
Restricted Stock Units
0
2024-05-17
4
A
0
21219
0
A
2027-05-17
2027-05-17
Common Stock
21219
21219
D
Stock Option (right to buy)
6.34
2024-05-17
4
A
0
96016
0
A
2034-05-17
Common Stock
96016
96016
D
Restricted Stock Units
2024-05-18
4
M
0
8077
0
D
Common Stock
8077
0
D
This total includes an additional 1,713 shares acquired recently through the Company's Employee Stock Purchase Plan
On May 17, 2024, 5,052 performance-based restricted stock units, granted on May 17, 2022, vested
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, 2024
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 18, 2024
Restricted stock units convert into common stock on a one-for-one basis.
The option, representing the right to purchase a total of 96,016 shares of InfuSystem Holdings, Inc. common stock, vests in four equal annual installments beginning May 17, 2025.
These restricted stock units will cliff vested on May 18, 2024.
/s/ Kevin Whitman, Attorney-in-Fact for Carrie Lachance
2024-05-21