SEC Form 3
FORM 3 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

INITIAL STATEMENT OF 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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1. Name and Address of Reporting Person*
Funke Jerod
(Last) (First) (Middle)
C/O INFUSYSTEM HOLDINGS, INC.
3851 WEST HAMLIN ROAD
(Street)
ROCHESTER HILLS MI 48309
(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
10/09/2023 		3. Issuer Name and Ticker or Trading Symbol
InfuSystem Holdings, Inc [ INFU ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director 10% Owner
X Officer (give title below) Other (specify below)
EVP-Chief HR Officer
 5. 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 Beneficially Owned
1. Title of Security (Instr. 4) 2. Amount of Securities Beneficially Owned (Instr. 4) 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 4. Nature of Indirect Beneficial Ownership (Instr. 5)
Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 4) 2. Date Exercisable and Expiration Date (Month/Day/Year) 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) 4. Conversion or Exercise Price of Derivative Security 5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 6. Nature of Indirect Beneficial Ownership (Instr. 5)
Date Exercisable Expiration Date Title Amount or Number of Shares
Stock Options (right to buy) (1) 10/09/2033 Common Stock 46,679 9.78 D
Restricted Stock Units (2) 10/09/2025 Common Stock 25,000 (3) D
Restricted Stock Units (4) 10/09/2026 Common Stock 7,157 (3) D
Explanation of Responses:
1. The option, representing the right to purchase a total of 46,679 shares of InfuSystem Holdings, Inc. common stock, vests in three equal annual installments beginning October 9, 2024.
2. These restricted stock units vest in two equal annual installments beginning on October 9, 2024.
3. Restricted stock units convert into common stock on a one-for-one basis.
4. These restricted stock units will fully vest on October 9, 2026.
Remarks:
/s/ Kevin Whitman, Attorney-in-Fact for Jerod Funke 10/19/2023
** 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 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.
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