UNITED STATES SECURITIES AND EXCHANGE COMMISSION ----------------------
FORM 3 Washington, D.C. 20549 | OMB APPROVAL |
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| OMB Number: |
INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES | 3235-0104 |
| Expires: |
| November 30, 2011 |
| Estimated average |
| burden hours per |
| response 0.5 |
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
(Print or Type Responses) Investment Company Act of 1940
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|1. Name and Address of | 2.Date of Event |3. Issuer Name and Ticker or Trading Symbol |
| Reporting Person* | Requiring | |
| | Statement | |
| | (Month/Day/Year)| |
|Eichenbaum Kenneth D. |05-16-2024 |InfuSystem Holdings, Inc INFU |
|-----------------------------------------| |--------------------------------------------------------------------|
| (Last) (First) (Middle) | |4. Relationship of Reporting Person(s) to |5. If Amendment, Date |
| | | Issuer (Check All Applicable) | Original Filed |
| | | | (Month/Day/Year) |
|C/O INFUSYSTEM HOLDINGS, INC.,3851 WEST H| | __X__ Director _____ 10% Owner | |
|AMLIN ROAD | | | |
|-----------------------------------------| | |-------------------------|
| (Street) | | _____ Officer _____ Other |6. Individual or |
| | | | Joint/Group Filing |
|ROCHESTER HILLS,MI 48309 | | (give title below) (specify below) | (Check Applicable Line) |
| (City) (State) (Zip) | | | _X_ Form filed by One |
| | | |Reporting Person |
| | | | ___ Form filed by More |
| | | |Than One Reporting Person|
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Table I -- Non-Derivative Securities Beneficially Owned
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| 1. | 2. | 3. | 4. |
| Title of Security (Instr. 4) | Amount of Securities | Ownership Form: | Nature of Indirect Beneficial |
| | Beneficially Owned | Direct (D) or | Ownership (Instr. 5) |
| | (Instr. 4) | Indirect (I) | |
| | | (Instr. 5) | |
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. SEC 1473 (7-02)
Persons who respond to the collection of information contained in this
form are not required to respond unless the form displays a currently
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Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
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|1. | 2. | 3. |4. |5. |6. |
|Title of Derivative Security | Date | Title and |Conversion |Ownership |Nature of |
| (Instr. 4) | Exercisable | Amount of |or Exercise|Form of |Indirect |
| | and Expira- | Underlying |Price of |Derivative |Beneficial |
| | tion Date | Securities |Derivative |Security: |Ownership |
| | (Month/Day/ | (Instr. 4) |Security |Direct(D) or |(Instr. 5) |
| | Year) | | |Indirect (I) | |
| |------------------------|------------------| |(Instr. 5) | |
| | | | |Amount or | | | |
| | | | |Number | | | |
| |Date |Expiration | |of | | | |
| |Exercisable |Date |Title |Shares | | | |
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|Stock Option (right to buy) |05-17-2025 |05-17-2034 |Common|35,685 |$6.34 |D | |
| | | | Stock| | | | |
| | | | |#1 | | | |
|---------------------------------------------------------------------------------------------------------------|
+----------------------------------------------------------------------------------+
| | Relationships |
| Reporting Owner Name / Address +----------+----------+----------+-------- -+
| | Director |10% Owner | Officer | Other |
+--------------------------------------+----------+----------+----------+----------+
|Eichenbaum Kenneth D. | X | . | | |
|C/O INFUSYSTEM HOLDINGS, INC. | | | | |
|3851 WEST HAMLIN ROAD | | | | |
|ROCHESTER HILLS MI 48309 | | | | |
|--------------------------------------+----------+----------+----------+----------|
Explanation of Responses:
1 The option, representing the right to purchase 35,685 shares of InfuSystem Holdings
, Inc. common stock, vests on May 17, 2025.
Remarks:
Signatures
/s/ Kevin Whitman, Attorney-in-Fact for Kenneth D. Eichenbau / 05-22-2024
m
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** Signature of Reporting Person Date
* If the form is filed by more than one reporting person, seeInstruction 5(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).
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, See Instruction 6 for procedure.
Potential persons who are to respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB number.
Exhibit 24 Power of Attorney Know all by these presents, that the undersigned
hereby makes, constitutes and appoints each of Kevin Whitman, Barry Steele and
David Miller, or any of them acting singly, and with full power of
substitution and re-substitution, the undersigned's true and lawful
attorney-in-fact (each of such persons and their substitutes being referred to
herein as the "Attorney-in-Fact"), with full power to act for the undersigned
and in the undersigned's name, place and stead, in any and all capacities, to:
1. Prepare, execute, and submit to the Securities and Exchange Commission
("SEC") a Form ID, including amendments thereto, and any other documents
necessary or appropriate to obtain codes and passwords enabling the
undersigned to make electronic filings with the SEC of reports required or
considered by the Attorney-in-Fact to be advisable under Section 13 or Section
16 of the Securities Exchange Act of 1934 (the "Exchange Act") or any rule or
regulation of the SEC; 2. Prepare, execute and submit to the SEC, InfuSystem
Holdings, Inc. (the "Company"), and/or any national securities exchange on
which the Company's securities are listed any and all reports (including any
amendments thereto) the undersigned is required to file with the SEC, or which
the Attorney-in- Fact considers it advisable to file with the SEC, under
Section 13 or Section 16 of the Exchange Act or any rule or regulation
thereunder, or under Rule 144 under the Securities Act of 1933 ("Rule 144"),
with respect to the any security of the Company, including Forms 3, 4 and 5,
Schedules 13D and 13G, and Forms 144; and 3. Obtain, as the undersigned's
representative and on the undersigned's behalf, information regarding
transactions in the Company's equity securities from any third party,
including the Company and any brokers, dealers, employee benefit plan
administrators and trustees, and the undersigned hereby authorizes any such
third party to release any such information to the Attorney-in-Fact. The
undersigned acknowledges that: a) This Power of Attorney authorizes, but does
not require, the Attorney-in-Fact to act in his or her discretion on
information provided to such Attorney-in-Fact without independent verification
of such information; b) Any documents prepared or executed by the
Attorney-in-Fact on behalf of the undersigned pursuant to this Power of
Attorney will be in such form and will contain such information as the
Attorney-in-Fact, in his or her discretion, deems necessary or desirable; c)
Neither the Company nor the Attorney-in-Fact assumes any liability for the
undersigned's responsibility to comply with the requirements of Section 13 or
Section 16 of the Exchange Act or Rule 144, any liability of the undersigned
for any failure to comply with such requirements, or any liability of the
undersigned for disgorgement of profits under Section 16(b) of the Exchange
Act; and d) This Power of Attorney does not relieve the undersigned from
responsibility for compliance with the undersigned's obligations under Section
13 or Section 16 of the Exchange Act, including, without limitation, the
reporting requirements under Section 13 or Section 16 of the Exchange Act. The
undersigned hereby grants to the Attorney-in-Fact full power and authority to
do and perform each and every act and thing requisite, necessary or advisable
to be done in connection with the foregoing, as fully, to all
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intents and purposes, as the undersigned might or could do in person, hereby
ratifying and confirming all that the Attorney-in-Fact, or his or her
substitute or substitutes, shall lawfully do or cause to be done by authority
of this Power of Attorney. This Power of Attorney shall remain in full force
and effect until the undersigned is no longer required to file Forms 4 or 5 or
Schedules 13D or 13G or Forms 144 with respect to the undersigned's holdings
of and transactions in securities of the Company, unless earlier revoked by
the undersigned in a signed writing delivered to the Attorney-in-Fact. This
Power of Attorney revokes all previous powers of attorney with respect to the
subject matter of this Power of Attorney. IN WITNESS WHEREOF, the undersigned
has executed this Power of Attorney as of May 16th, 2024. /s/ Dr. Kenneth D.
Eichenbaum Signature Dr. Kenneth D. Eichenbaum
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