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