InfuSystem Holdings Inc.

05/20/2025 | Press release | Distributed by Public on 05/20/2025 16:55

Statement of Changes in Beneficial Ownership (Form 4)

FORM 4
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
Check this box to indicate that a transaction was made pursuant to a contract, instruction or written plan that is intended to satisfy the affirmative defense conditions of Rule 10b5-1(c). See Instruction 10.
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 or Section 30(h) of the Investment Company Act of 1940
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OMB Number: 3235-0287
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(Print or Type Responses)
1. Name and Address of Reporting Person *
Lachance Carrie
2. Issuer Name and Ticker or Trading Symbol
InfuSystem Holdings, Inc [INFU]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
__X__ Director _____ 10% Owner
__X__ Officer (give title below) _____ Other (specify below)
President and COO
(Last) (First) (Middle)
C/O INFUSYSTEM HOLDINGS, INC., 3851 WEST HAMLIN ROAD
3. Date of Earliest Transaction (Month/Day/Year)
05/16/2025
(Street)
ROCHESTER HILLS, MI 48309
4. If Amendment, Date Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
_X_ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person
(City) (State) (Zip)
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
1.Title of Security
(Instr. 3)
2. Transaction Date (Month/Day/Year) 2A. Deemed Execution Date, if any (Month/Day/Year) 3. Transaction Code
(Instr. 8)
4. Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
5. Amount of Securities Beneficially Owned Following Reported Transaction(s)
(Instr. 3 and 4)
6. Ownership Form: Direct (D) or Indirect (I)
(Instr. 4)
7. Nature of Indirect Beneficial Ownership
(Instr. 4)
Code V Amount (A) or (D) Price
Common Stock 190,212 D
Common Stock 05/17/2025 M 17,727 A $ 0 207,939 D
Common Stock 05/17/2025 F(1) 6,090 D $6.15 201,849 D
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)
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
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)
Code V (A) (D) Date Exercisable Expiration Date Title Amount or Number of Shares
Stock Options (right to buy) $6 05/16/2025 A 74,228 05/16/2026(2) 05/16/2035 Common Stock 74,228 $ 0 74,228 D
Stock Option (right to buy) $6 05/16/2025 A 128,000 05/16/2026(2) 05/16/2035 Common Stock 128,000 $ 0 128,000 D
Restricted Stock Units (3) 05/16/2025 A 31,250 05/16/2026(4) 05/16/2028 Common Stock 31,250 $ 0 31,250 D
Restricted Stock Units (3) 05/17/2025 M 17,727 (5) (5) Common Stock 17,727 $ 0 0 D

Reporting Owners

Reporting Owner Name / Address Relationships
Director 10% Owner Officer Other
Lachance Carrie
C/O INFUSYSTEM HOLDINGS, INC.
3851 WEST HAMLIN ROAD
ROCHESTER HILLS, MI 48309
X President and COO

Signatures

/s/ Kevin Whitman, Attorney-in-Fact for Carrie Lachance 05/20/2025
**Signature of Reporting Person Date

Explanation of Responses:

* 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) 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, 2025
(2) The option, representing the right to purchase a total of 74,228 shares of InfuSystem Holdings, Inc. common stock, vests in four equal annual installments beginning May 16, 2026.
(3) Restricted stock units convert into common stock on a one-for-one basis.
(4) These restricted stock units vest in three equal annual installments beginning on May 16, 2026.
(5) These restricted stock units cliff vested on May 17, 2025.
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.
InfuSystem Holdings Inc. published this content on May 20, 2025, and is solely responsible for the information contained herein. Distributed via Edgar on May 20, 2025 at 22:55 UTC. If you believe the information included in the content is inaccurate or outdated and requires editing or removal, please contact us at [email protected]