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 | ||||
Warrant to Purchase Common Shares | 10/26/2007 | 04/11/2011 | Common Stock | 500,000 (1) | $ 5 | I | See Footnote (2) |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
KLEINHEINZ CAPITAL PARTNERS INC 201 MAIN STREET SUITE 2001 FORT WORTH, TX 76102 |
 |  X |  |  |
Kleinheinz Capital Partners LDC 201 MAIN STREET SUITE 2001 FORT WORTH, TX 76102 |
 |  X |  |  |
KLEINHEINZ JOHN B 201 MAIN STREET SUITE 2001 FORT WORTH, TX 76102 |
 |  X |  |  |
/s/ John Kleinheinz, Director of Kleinheinz Capital Partners, Inc. | 12/19/2007 | |
**Signature of Reporting Person | Date | |
/s/ John Kleinheinz, Managing Director of Kleinheinz Capital Partners, LDC | 12/19/2007 | |
**Signature of Reporting Person | Date | |
/s/ John Kleinheinz | 12/19/2007 | |
**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) | The filing of this Form 3 shall not be construed as an admission that Kleinheinz Capital Partners, Inc., Kleinheinz Capital Partners LDC or John Kleinheinz is or was for the purpose of Section 16(a) of the Securties Exchange Act of 1934, as amended, or otherwise a beneficial owner of any of the shares of common stock ("Common Stock") or Warrants to purchase Common Stock ("Warrants") of Infusystem Holdings, Inc. owned by Global Undervalued Securities Fund, LP, Global Undervalued Securities Fund (QP), LP, Global Undervalued Securities Fund, Ltd. or Global Undervalued Securities Master Fund, LP. Pursuant to Rule 16a-1, each of Kleinheinz Capital Partners, Inc., Kleinheinz Capital Partners LDC and John Kleinheinz disclaims such beneficial ownership. |
(2) | Kleinheinz Capital Partners LDC holds indirectly shares of Common Stock and Warrants on behalf of Global Undervalued Securities Fund, LP, and Global Undervalued Securities Fund (QP), LP for which Kleinheinz Capital Partners LDC serves as general partner. Kleinheinz Capital Partners, Inc. holds indirectly shares of Common Stock and Warrants on behalf of Global Undervalued Securities Fund, LP, Global Undervalued Securities Fund (QP), LP, Global Undervalued Securitites Fund, Ltd. and Global Undervalued Securities Master Fund, LP, for which Kleinheinz Capital Partners, Inc. serves as investment manager. John Kleinheinz report the shares of Common Stock and Warrants held indirectly by Kleinheinz Capital Partners LDC and Kleinheinz Capital Partners, Inc. because, as managing director and director, respectively, at the time of purchase, he controlled the voting and disposition of the securitites. |