UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(h) of the Investment Company Act of 1940 |
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | SEC 1473 (7-02) | ||
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. |
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 of Derivative Security: Direct (D) or Indirect (I) (Instr. 5) |
6. Nature of Indirect Beneficial Ownership (Instr. 5) |
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Date Exercisable | Expiration Date | Title | Amount or Number of Shares |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
KLEINHEINZ CAPITAL PARTNERS, INC. 301 COMMERCE STREET, SUITE 1900 FORT WORTH, TX 76102 |
 |  |  | Member of 10% owner group |
Kleinheinz Capital Partners LDC C/O WALKERS SPV LIMITED WALKER HOUSE, 87 MARY STREET GEORGE TOWN, GRAND CAYMAN, E9 KY1-9002 |
 |  |  | Member of 10% owner group |
KLEINHEINZ JOHN B 301 COMMERCE STREET, SUITE 1900 FORT WORTH, TX 76102 |
 |  |  | Member of 10% owner group |
GLOBAL UNDERVALUED SECURITIES MASTER FUND LP C/O BNY MELLON ALTERNATIVE INVEST. SVCS. 48 PAR-LA-VILLE ROAD, SUITE 464 HAMILTON, D0 HM 11 |
 |  |  | Member of 10% owner group |
GLOBAL UNDERVALUED SECURITIES FUND LP C/O BNY MELLON ALTERNATIVE INVEST. SVCS. 48 PAR-LA-VILLE ROAD, SUITE 464 HAMILTON, D0 HM 11 |
 |  |  | Member of 10% owner group |
Global Undervalued Securities Fund QP L P C/O BNY MELLON ALTERNATIVE INVEST. SVCS. 48 PAR-LA-VILLE ROAD, SUITE 464 HAMILTON, D0 HM 11 |
 |  |  | Member of 10% owner group |
Global Undervalued Securities Fund Ltd C/O BNY MELLON ALTERNATIVE INVEST. SVCS. 48 PAR-LA-VILLE ROAD, SUITE 464 HAMILTON, D0 HM 11 |
 |  |  | Member of 10% owner group |
/s/ John B. Kleinheinz, President of Kleinheinz Capital Partners, Inc. | 12/06/2011 | |
**Signature of Reporting Person | Date | |
/s/ John B. Kleinheinz, Managing Director of Kleinheinz Capital Partners LDC | 12/06/2011 | |
**Signature of Reporting Person | Date | |
/s/ John B. Kleinheinz | 12/06/2011 | |
**Signature of Reporting Person | Date | |
/s/ John B. Kleinheinz, President of Kleinheinz Capital Partners, Inc., investment manager of Global Undervalued Securities Fund, L.P., general partner of Global Undervalued Securities Master Fund, L.P. | 12/06/2011 | |
**Signature of Reporting Person | Date | |
/s/ John B. Kleinheinz, President of Kleinheinz Capital Partners, Inc., investment manager of Global Undervalued Securities Fund, L.P. | 12/06/2011 | |
**Signature of Reporting Person | Date | |
/s/ John B. Kleinheinz, President of Kleinheinz Capital Partners, Inc., investment manager of Global Undervalued Securities Fund (QP), L.P. | 12/06/2011 | |
**Signature of Reporting Person | Date | |
/s/ John B. Kleinheinz, Director of Global Undervalued Securities Fund, Ltd. | 12/06/2011 | |
**Signature of Reporting Person | Date |
* | 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). |
(1) | Represents shares of common stock ("Common Stock") of Infusystem Holdings, Inc. (the "Issuer") directly beneficially owned by Global Undervalued Securities Master Fund, L.P. ("Global Master"). |
(2) | On December 6, 2011, Kleinheinz Capital Partners, Inc. ("Kleinheinz Capital"), Kleinheinz Capital Partners LDC ("LDC"), Global Undervalued Securities Fund, L.P. ("Global, L.P."), Global Undervalued Securities Fund (QP), L.P. ("Global QP"), Global Undervalued Securities Fund, Ltd. ("Global Ltd."), Global Master, and John B. Kleinheinz ("Mr. Kleinheinz", and collectively with Kleinheinz Capital, LDC, Global, L.P., Global QP, Global Ltd. and Global Master, the "Reporting Persons") and certain other persons made a joint filing under Section 13(d) of the Securities Exchange Act of 1934, as amended (the "Exchange Act"), and, therefore, may be deemed to beneficially own Common Stock beneficially owned by the other persons in such joint filing. The Reporting Persons disclaim beneficial ownership of and any pecuniary interest in any shares of Common Stock beneficially owned by such other persons. |
(3) | This Form 3 and the filing hereof shall not be deemed an admission that any Reporting Person is a beneficial owner of any shares of Common Stock for any purpose, other than the Common Stock reported in Table 1, or that any Reporting Person is a member of a "group." This Form 3 does not reflect any Common Stock beneficially owned by any person other than the Reporting Persons. |
(4) | Mr. Kleinheinz, as the sole director and President of Kleinheinz Capital and as a director of LDC; Kleinheinz Capital, as the investment manager of Global, L.P., Global QP, Global Ltd. and Global Master; LDC, as the general partner of Global, L.P. and Global QP; Global, L.P., as a general partner of Global Master; Global QP, as a general partner of Global Master; and Global Ltd., as a general partner of Global Master, may in each case be deemed to be beneficial owners of the Common Stock reported herein for purposes of Rule 16a-1(a) of the Exchange Act. Mr. Kleinheinz, Kleinheinz Capital, LDC, Global, L.P., Global QP, and Global Ltd. disclaim any beneficial ownership of any Common Stock, except to the extent of any pecuniary interest therein. |