SEC Form 3 · accession 0001437749-19-002934

InfuSystem Holdings, Inc · INFU

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

Reporting owner

Officer — VP OF SALES AND MARKETING

Period of report

Feb 12, 2019

Accepted (ET)

Feb 20, 2019 · 3:14 pm EST

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	holding	—	—		—	5,337	D

Security	Conv. / exercise price	Date	Code	Shares	A/D	Exercisable	Expires	Underlying	Underlying shares	Owned after	D/I
Stock Option (Right to Buy)	$2.69	holding	—	—	—	Jul 31, 2017	Dec 8, 2024	Common Stock	50,000	—	D
Stock Option (Right to Buy)^F1	$2.76	holding	—	—	—	—	Aug 18, 2026	Common Stock	40,000	—	D
Stock Option (Right to Buy)^F2	$2.15	holding	—	—	—	—	Mar 15, 2027	Common Stock	25,000	—	D
Stock Option (Right to Buy)^F3	$1.98	holding	—	—	—	—	Sep 6, 2022	Common Stock	25,000	—	D
Stock Option (Right to Buy)^F4	$3.36	holding	—	—	—	—	Jul 19, 2023	Common Stock	25,000	—	D
Restricted Stock Units^F5,F6	—	holding	—	—	—	Mar 11, 2019	Mar 12, 2019	Common Stock	2,083	—	D

F1The option, representing the right to purchase a total of 40,000 shares, became exercisable in 36 equal monthly installments following the August 18, 2016 date of grant.
F2The option, representing the right to purchase a total of 25,000 shares, became exercisable in 36 equal monthly installments following the March 16, 2017 date of grant.
F3Stock option vests 33% per year on anniversary date starting September 7, 2018
F4Stock option vests 33% per year on anniversary date starting July 19, 2019
F5Restricted stock units convert into common stock on a one-for-one basis.
F6The reporting person was awarded restricted stock units on March 11, 2015, which vest in one remaining annual installment on March 11th of 2019. Settlement of the underlying shares of common stock will occur on vesting date, assuming continued employment through the applicable vesting date.