SEC Form 4 · accession 0001140361-15-022929
InfuSystem Holdings, Inc · INFU
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
David C Dreyer
Director
Period of report
May 29, 2015
Accepted (ET)
Jun 2, 2015 · 6:40 pm EDT
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0001337013
Table I — non-derivative securities
| Security | Date | Code | Shares | Price | A/D | Owned after | D/I | Nature of ownership |
|---|---|---|---|---|---|---|---|---|
| Common Stock | May 29, 2015 | M | 25,000 | $1.52 | A | 152,497 | D | |
| Common StockF1 | May 29, 2015 | F | 12,063 | $3.15 | D | 140,434 | D |
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) | $1.52 | May 29, 2015 | M | 25,000 | D | Aug 29, 2013 | Aug 28, 2015 | Common Stock | 25,000 | 0 | D |
Explanation of responses
- F1Reflects the number of shares surrendered in connection with the cashless exercise of the option.
Remarks
Exhibit List: Exhibit 24 - Power of Attorney