InfuSystem Holdings, Inc — Director's Dealing 2019

Apr 1, 2019

SEC Form 4 — Statement of Changes in Beneficial Ownership

Issuer: InfuSystem Holdings, Inc (INFU)
CIK: 0001337013
Period of Report: 2019-03-28

Reporting Person: Dilorio Richard (Director, President & CEO)

Non-Derivative Transactions

Date	Security	Code	Shares	Price	A/D	Holdings After	Ownership
2019-03-28	Common Stock	M	25000	—	Acquired	117028	Direct
2019-03-28	Common Stock	F	7350	$4.14	Disposed	109678	Direct
2019-03-29	Common Stock	M	200000	$2	Acquired	309678	Direct
2019-03-29	Common Stock	F	117754	$4.79	Disposed	191924	Direct

Derivative Transactions

Date	Security	Exercise Price	Code	Shares	A/D	Expiration	Underlying	Ownership
2019-03-29	Stock Appreciation Rights	$2	M	200000	Disposed	2019-03-31	Common Stock (200000)	Direct
2019-03-28	Restricted Stock Units	$	M	25000	Disposed		Common Stock (25000)	Direct

Footnotes

F1: Represents the acquisition of the Issuer's common stock by reporting person pursuant to the vesting and settlement of a portion of the restricted stock units (RSUs) granted on August 23, 2018. Restricted stock units convert into common stock on a one-for-one basis.

F2: Represents the withholding of the Issuer's common stock for the tax liability associated with the vesting and settlement of a portion of the restricted stock units (RSUs) granted on August 23, 2018.

F3: Represents the acquisition of the Issuer's common stock by reporting person pursuant to the exercise of the Stock Appreciation Rights granted on November 15, 2017.

F4: Represents the difference between the number of the Stock Appreciation Rights exercised and the number of shares issued as a result of the exercise.

F5: Represents the withholding of the Issuer's common stock for the tax liability associated with the exercise of the Stock Appreciation Rights granted on November 15, 2017.