0001596771-17-000088.txt : 20171129 0001596771-17-000088.hdr.sgml : 20171129 20171129165427 ACCESSION NUMBER: 0001596771-17-000088 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20171122 FILED AS OF DATE: 20171129 DATE AS OF CHANGE: 20171129 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: ERB JOHN L CENTRAL INDEX KEY: 0001213867 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-35312 FILM NUMBER: 171228973 MAIL ADDRESS: STREET 1: C/O VASCULAR SOLUTIONS, INC. STREET 2: 6464 SYCAMORE COURT N. CITY: MINNEAPOLIS, STATE: MN ZIP: 55369 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: CHF Solutions, Inc. CENTRAL INDEX KEY: 0001506492 STANDARD INDUSTRIAL CLASSIFICATION: ELECTROMEDICAL & ELECTROTHERAPEUTIC APPARATUS [3845] IRS NUMBER: 680533453 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 12988 VALLEY VIEW ROAD CITY: EDEN PRAIRIE STATE: MN ZIP: 55344 BUSINESS PHONE: 952-345-4200 MAIL ADDRESS: STREET 1: 12988 VALLEY VIEW ROAD CITY: EDEN PRAIRIE STATE: MN ZIP: 55344 FORMER COMPANY: FORMER CONFORMED NAME: Sunshine Heart, Inc. DATE OF NAME CHANGE: 20101124 4 1 primary_doc.xml PRIMARY DOCUMENT X0306 4 2017-11-22 0 0001506492 CHF Solutions, Inc. CHFS 0001213867 ERB JOHN L 12988 VALLEY VIEW ROAD EDEN PRAIRIE MN 55344 1 1 0 0 CEO and President Series F Convertible Preferred Stock 4.5 2017-11-22 4 P 0 100 A 2017-11-22 Common Stock 22222 100 D Series 1 Warrant to Purchase Common Stock (right to buy) 4.5 2017-11-22 4 P 0 100 A 2017-11-22 2018-11-22 Common Stock 22300 100 D Series 2 Warrant to Purchase Common Stock (right to buy) 4.5 2017-11-22 4 P 0 100 A 2017-11-22 2024-11-22 Common Stock 22300 100 D The Series F Convertible Preferred Stock (the "Preferred Stock") has no expiration date. The reporting person purchased the Preferred Stock for $995.54 per share in an underwritten public offering that closed on November 27, 2017. For each share of Preferred Stock purchased, the reporting person also received one warrant to purchase 223 shares of common stock (the Series 1 warrant), and one warrant to purchase 223 shares of common stock (the Series 2 warrant). The Preferred Stock and warrants were issued separately. Gayle C. Aiken, by Power of Attorney 2017-11-29