InfuSystem (INFU) Form 4 InfuSystem / Carrie Lachance ownership change

SEC Form 4

FORM 4

UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP

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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Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).

1. Name and Address of Reporting Person^*

Lachance Carrie

(Last) (First) (Middle)

C/O INFUSYSTEM HOLDINGS, INC.

3851 WEST HAMLIN ROAD

(Street)

ROCHESTER HILLS MI 48309

(City) (State) (Zip)

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

3. Date of Earliest Transaction (Month/Day/Year)
05/17/2024

4. If Amendment, Date of 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

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								175,426(1)	D
Common Stock	05/17/2024		A		5,052(2)	A	$0	180,478	D
Common Stock	05/17/2024		F(3)		1,988	D	$6.44	178,490	D
Common Stock	05/18/2024		M		8,077	A	$0	186,567	D
Common Stock	05/18/2024		F		3,179(4)	D	$6.44	183,388	D

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 Securities Underlying Derivative Security (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: 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
Restricted Stock Units	$0(5)	05/17/2024		A		21,219		05/17/2027	05/17/2027	Common Stock	21,219	$0	21,219	D
Stock Option (right to buy)	$6.34	05/17/2024		A		96,016		(6)	05/17/2034	Common Stock	96,016	$0	96,016	D
Restricted Stock Units	(5)	05/18/2024		M			8,077	(7)	(7)	Common Stock	8,077	$0	0	D

Explanation of Responses:

1. This total includes an additional 1,713 shares acquired recently through the Company's Employee Stock Purchase Plan

2. On May 17, 2024, 5,052 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. Restricted stock units convert into common stock on a one-for-one basis.

6. The option, representing the right to purchase a total of 96,016 shares of InfuSystem Holdings, Inc. common stock, vests in four equal annual installments beginning May 17, 2025.

7. These restricted stock units will cliff vested on May 18, 2024.

Remarks:

	/s/ Kevin Whitman, Attorney-in-Fact for Carrie Lachance	05/21/2024
	** Signature of Reporting Person	Date
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
* 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).
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