SEC Form 4 · accession 0001014108-17-000070
InfuSystem Holdings, Inc · INFU
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Janet Skonieczny
Officer — EVP & Chief Operating Officer
Period of report
Mar 16, 2017
Accepted (ET)
Mar 22, 2017 · 3:14 pm EDT
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0001337013
Table I — non-derivative securities
No Table I lines on this filing.
Table II — derivative securities
| Security | Conv. / exercise price | Date | Code | Shares | A/D | Exercisable | Expires | Underlying | Underlying shares | Owned after | D/I |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Stock Option (right to buy)F1 | $2.15 | Mar 16, 2017 | A | 25,000 | A | — | Mar 16, 2027 | Common Stock | 25,000 | 25,000 | D |
Explanation of responses
- F1The option, representing the right to purchase a total of 25,000 shares of InfuSystem Holdings, Inc. common stock, vests in 36-monthly installments beginning April 16, 2017.