Filing Details
- Accession Number:
- 0001014108-21-000117
- Form Type:
- 4
- Zero Holdings:
- No
- Publication Time:
- 2021-05-21 11:11:27
- Reporting Period:
- 2021-05-18
- Accepted Time:
- 2021-05-21 11:11:27
- SEC Url:
- Form 4 Filing
Issuer
| Cik | Name | Symbol | Sector (SIC) | IRS No |
|---|---|---|---|---|
| 1337013 | Infusystem Holdings Inc | INFU | Surgical & Medical Instruments & Apparatus (3841) | 203341405 |
Insiders
| Cik | Name | Reported Address | Insider Title | Director | Officer | Large Shareholder | Other |
|---|---|---|---|---|---|---|---|
| 1775188 | Jeannine Sheehan | 31700 Research Park Drive Madison Heights MI 48071 | Chief Administrative Officer | No | Yes | No | No |
Reported Non-Derivative Transactions
| Sec. Name | Acquisiton - Disposition | Date | Amount | Price | Remaning Holdings | Equity Swap Involved | Form Type | Code | Nature of Ownership | Explanation |
|---|---|---|---|---|---|---|---|---|---|---|
| Common Stock | Acquisiton | 2021-05-18 | 0 | $0.00 | 9,164 | No | 4 | P | Direct | |
| Common Stock | Acquisiton | 2021-05-18 | 0 | $0.00 | 195 | No | 4 | P | Indirect | By children |
| Common Stock | Acquisiton | 2021-05-18 | 0 | $0.00 | 345 | No | 4 | P | Indirect | By children |
| Equity Swap Involved | Form Type | Code | Nature of Ownership | Explanation |
|---|---|---|---|---|
| No | 4 | P | Direct | |
| No | 4 | P | Indirect | By children |
| No | 4 | P | Indirect | By children |
Reported Derivative Transactions
| Sec. Name | Sec. Type | Acquisiton - Disposition | Date | Amount | Price | Amount - 2 | Price - 2 |
|---|---|---|---|---|---|---|---|
| Common Stock | Stock Option (right to buy) | Acquisiton | 2021-05-18 | 9,775 | $0.00 | 9,775 | $19.50 |
| Common Stock | Restricted Stock Units | Acquisiton | 2021-05-18 | 6,667 | $0.00 | 6,667 | $0.00 |
| Common Stock | Restricted Stock Units | Acquisiton | 2021-05-18 | 2,821 | $0.00 | 2,281 | $0.00 |
| Remaning Holdings | Exercise Date | Expiration Date | Equity Swap Involved | Transaction Form Type | Transaction Code | Nature of Ownership |
|---|---|---|---|---|---|---|
| 9,775 | 2031-05-18 | No | 4 | A | Direct | |
| 6,667 | No | 4 | A | Direct | ||
| 2,281 | No | 4 | A | Direct |
Footnotes
- The option, representing the right to purchase a total of 9,775 shares of InfuSystem Holdings, Inc. common stock, vests in three equal annual installments beginning May 18, 2022.
- Restricted stock units convert into common stock on a one-for-one basis.
- These restricted stock units will cliff vest on May 18, 2024.
- These restricted stock units will cliff vest on May 18, 2022.
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