SEC Form 4 · accession 0001140361-15-033653
InfuSystem Holdings, Inc · INFU
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Wayne P. Yetter
Director
Period of report
Aug 25, 2015
Accepted (ET)
Aug 27, 2015 · 6:11 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 | Aug 25, 2015 | M | 25,000 | $1.52 | A | 407,470 | D | |
| Common StockF1 | Aug 25, 2015 | F | 16,881 | $2.87 | D | 390,589 | 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)F2 | $1.52 | Aug 25, 2015 | M | 25,000 | D | — | 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.
- F2The option, representing the right to purchase a total of 25,000 shares, became exercisable in twelve equal monthly installments beginning August 29, 2013 and immediately upon a change in control.