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