0001628280-24-030522.txt : 20240628 0001628280-24-030522.hdr.sgml : 20240628 20240628184114 ACCESSION NUMBER: 0001628280-24-030522 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20240626 FILED AS OF DATE: 20240628 DATE AS OF CHANGE: 20240628 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Dilorio Richard CENTRAL INDEX KEY: 0001706994 ORGANIZATION NAME: FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-35020 FILM NUMBER: 241087356 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_1719614468.xml FORM 4 X0508 4 2024-06-26 0 0001337013 InfuSystem Holdings, Inc INFU 0001706994 Dilorio Richard C/O INFUSYSTEM HOLDINGS, INC. 3851 WEST HAMLIN ROAD ROCHESTER HILLS MI 48309 1 1 0 0 Chief Executive Officer 0 Common Stock 2024-06-26 4 M 0 50000 2.69 A 490121 D Common Stock 2024-06-26 4 F 0 34347 6.83 D 455774 D Stock Option (right to buy) 2.69 2024-06-26 4 M 0 50000 0 D 2024-07-14 Common Stock 50000 0 D Reflects the number of shares surrendered in connection with the cashless exercise and tax withholding obligations for the exercised option. The option, representing the right to purchase a total of 50,000 shares of InfuSystem Holdings, Inc. common stock, vested in thirty-six monthly installments beginning August 14, 2014. /s/ Kevin Whitman, Attorney-in-Fact for Richard Dilorio 2024-06-28