SEC Form 4 · accession 0001437749-18-018380

InfuSystem Holdings, Inc · INFU

Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗

Reporting owner

Director

Period of report

Oct 15, 2018

Accepted (ET)

Oct 17, 2018 · 12:52 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
Common Stock	Oct 15, 2018	M	25,000	$2.39	A	25,000	D
Common Stock^F1	Oct 15, 2018	F	20,538	$3.24	D	4,462	D
Common Stock	Oct 15, 2018	M	20,833	$1.98	A	25,295	D
Common Stock^F1	Oct 15, 2018	F	15,330	$3.24	D	9,965	D

Security	Conv. / exercise price	Date	Code	Shares	A/D	Exercisable	Expires	Underlying	Underlying shares	Owned after	D/I
Stock Option (Right to Buy)^F2,F3	$2.39	Oct 15, 2018	M	25,000	D	Jan 18, 2018	Oct 19, 2018	Common Stock	25,000	0	D
Stock Option (Right to Buy)^F4,F3	$1.98	Oct 15, 2018	M	20,833	D	Jul 19, 2018	Oct 19, 2018	Common Stock	20,833	0	D

F1Reflects the number of shares surrendered in connection with the cashless exercise and tax withholding obligations for the exercised option.
F2The option, representing the right to purchase a total of 25,000 shares, became exercisable in twelve equal monthly installments following the January 18, 2017 date of grant.
F3The reporting person ceased to be a Director of the Company on July 19, 2018. The option expires three months after the date Optionee ceased to be a Director of the Company.
F4The option, representing the right to purchase a total of 20,833 shares, became exercisable in ten equal monthly installments following the September 17, 2017 date of grant. All vesting ceased upon termination of the reporting person's service as a Director of the Company on July 19, 2018.