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* RUIZ THOMAS MARK (Last) (First) (Middle) 31700 RESEARCH PARK DRIVE (Street) MADISON HEIGHTS MI 48071 (City) (State) (Zip)	2. Date of Event Requiring Statement (Month/Day/Year) 02/12/2019	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) VP OF SALES AND MARKETING	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)
Common Stock	5,337	D

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 Option (Right to Buy)	07/31/2017	12/08/2024	Common Stock	50,000	$2.69	D
Stock Option (Right to Buy)	(1)	08/18/2026	Common Stock	40,000	$2.76	D
Stock Option (Right to Buy)	(2)	03/15/2027	Common Stock	25,000	$2.15	D
Stock Option (Right to Buy)	(3)	09/06/2022	Common Stock	25,000	$1.98	D
Stock Option (Right to Buy)	(4)	07/19/2023	Common Stock	25,000	$3.36	D
Restricted Stock Units	03/11/2019(6)	03/12/2019(6)	Common Stock	2,083	(5)	D

Explanation of Responses:

1. The option, representing the right to purchase a total of 40,000 shares, became exercisable in 36 equal monthly installments following the August 18, 2016 date of grant.

2. The option, representing the right to purchase a total of 25,000 shares, became exercisable in 36 equal monthly installments following the March 16, 2017 date of grant.

3. Stock option vests 33% per year on anniversary date starting September 7, 2018

4. Stock option vests 33% per year on anniversary date starting July 19, 2019

5. Restricted stock units convert into common stock on a one-for-one basis.

6. The reporting person was awarded restricted stock units on March 11, 2015, which vest in one remaining annual installment on March 11th of 2019. Settlement of the underlying shares of common stock will occur on vesting date, assuming continued employment through the applicable vesting date.

	/s/ Thomas M. Ruiz	02/20/2019
	** 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).
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