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UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(h) of the Investment Company Act of 1940 |
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| Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | |||
| Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB control number. | SEC 1474 (9-02) | ||
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1. Title of Derivative Security (Instr. 3) |
2. Conversion or Exercise Price of Derivative Security | 3. Transaction Date (Month/Day/Year) | 3A. Deemed Execution Date, if any (Month/Day/Year) |
4. Transaction Code (Instr. 8) |
5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4, and 5) |
6. Date Exercisable and Expiration Date (Month/Day/Year) |
7. Title and Amount of Underlying Securities (Instr. 3 and 4) |
8. Price of Derivative Security (Instr. 5) |
9. Number of Derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) |
10. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 4) |
11. Nature of Indirect Beneficial Ownership (Instr. 4) |
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| Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||||||
| Restricted Stock Units | $ 0 (6) | 05/17/2024 | A | 20,702 | 05/17/2027 | 05/17/2027 | Common Stock | 20,702 | $ 0 | 20,702 | D | ||||
| Stock Option (right to buy) | $ 6.34 | 05/17/2024 | A | 93,674 | (7) | 05/17/2034 | Common Stock | 93,674 | $ 0 | 93,674 | D | ||||
| Restricted Stock Units | (6) | 05/18/2024 | M | 7,051 | (8) | (8) | Common Stock | 7,051 | $ 0 | 0 | D | ||||
| Reporting Owner Name / Address | Relationships | |||
| Director | 10% Owner | Officer | Other | |
| Steele Barry G C/O INFUSYSTEM HOLDINGS, INC. 3851 WEST HAMLIN ROAD ROCHESTER HILLS, MI 48309 |
Executive VP and CFO | |||
| /s/ Kevin Whitman, Attorney-in-Fact for Barry G. Steele | 05/21/2024 | |
| **Signature of Reporting Person | Date |
| * | If the form is filed by more than one reporting person, see Instruction 4(b)(v). |
| ** | Intentional misstatements or omissions of facts constitute Federal Criminal Violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). |
| (1) | This total includes an additional 2,949 shares acquired recently through the Company's Employee Stock Purchase Plan |
| (2) | On May 17, 2024, 3,886 performance-based restricted stock units, granted on May 17, 2022, vested |
| (3) | Represents the withholding of the Issuer's common stock for the tax liability associated with the vesting and settlement of the common stock issued on May 17, 2024 |
| (4) | Represents the withholding of the Issuer's common stock for the tax liability associated with the vesting and settlement of the common stock issued on May 18, 2024 |
| (5) | The price reported in Column 4 is a weighted average price. These shares reported herein were purchased in multiple transactions. The reporting person undertakes to provide to the Issuer, and security holder of the Issuer, or the staff of the Securities and Exchange Commission, upon request, full information regarding the number of shares purchased at each separate price. |
| (6) | Restricted stock units convert into common stock on a one-for-one basis. |
| (7) | The option, representing the right to purchase a total of 93,674 shares of InfuSystem Holdings, Inc. common stock, vests in four equal annual installments beginning May 17, 2025. |
| (8) | These restricted stock units will cliff vested on May 18, 2024. |