0001596771-18-000001.txt : 20180105 0001596771-18-000001.hdr.sgml : 20180105 20180105161247 ACCESSION NUMBER: 0001596771-18-000001 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20180103 FILED AS OF DATE: 20180105 DATE AS OF CHANGE: 20180105 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Breidenstein Jim CENTRAL INDEX KEY: 0001705206 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-35312 FILM NUMBER: 18513545 MAIL ADDRESS: STREET 1: 12988 VALLEY VIEW ROAD CITY: EDEN PRAIRIE STATE: MN ZIP: 55344 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 2018-01-03 0 0001506492 CHF Solutions, Inc. CHFS 0001705206 Breidenstein Jim 12988 VALLEY VIEW ROAD EDEN PRAIRIE MN 55344 0 1 0 0 Chief Commercial Officer Incentive Stock Option (right to buy) 3.5 2018-01-03 4 A 0 181068 0 A 2028-01-03 Common Stock 181068 181068 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 that all of the options will be vested on the four-year anniversary of the date of grant. /s/ Stephanie Swan, by Power of Attorney 2018-01-05