0001596771-18-000003.txt : 20180119 0001596771-18-000003.hdr.sgml : 20180119 20180119160921 ACCESSION NUMBER: 0001596771-18-000003 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20180117 FILED AS OF DATE: 20180119 DATE AS OF CHANGE: 20180119 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: 18537473 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 2018-01-17 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 Incentive Stock Option (right to buy) 3.55 2018-01-17 4 A 0 659193 0 A 2028-01-16 Common Stock 659193 659193 D The options will vest as follows: 25% of the options will vest on the one-year anniversary of the date of grant; the remaining options will vest in 36 equal consecutive monthly increments thereafter, so all will be vested on the four-year anniversary of the date of grant. /s/ Gayle C. Aiken, by Power of Attorney 2018-01-19