0001856466-21-000001.txt : 20210416 0001856466-21-000001.hdr.sgml : 20210416 20210416111205 ACCESSION NUMBER: 0001856466-21-000001 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 2 CONFORMED PERIOD OF REPORT: 20210416 FILED AS OF DATE: 20210416 DATE AS OF CHANGE: 20210416 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Wotta Paul CENTRAL INDEX KEY: 0001856466 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-35312 FILM NUMBER: 21830489 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 3 1 primary_doc.xml PRIMARY DOCUMENT X0206 3 2021-04-16 0 0001506492 CHF Solutions, Inc. CHFS 0001856466 Wotta Paul 12988 VALLEY VIEW ROAD EDEN PRAIRIE MN 55344 0 1 0 0 Principal Accounting Officer Incentive Stock Option 1470 2018-01-03 2028-01-03 Common Stock 71 D Incentive Stock Option 9.3 2021-01-22 2031-01-22 Common Stock 1250 D Exhibit 24, Power of Attorney, is attached. /s/ Thomas Lynch, by Power of Attorney 2021-04-16 EX-24 2 poapaulwotta.txt POWER OF ATTORNEY For Section 16(a) Securities and Exchange Act of 1934 Filings KNOW ALL BY THESE PRESENTS, that the undersigned hereby constitutes and appoints each of Nestor Jaramillo, Jr., Thomas Lynch, Phillip D. Torrence, and Stephanie Swan, signing singly, the undersigneds true and lawful attorney in fact to: 1. Do and perform all acts for and on behalf the undersigned which may be necessary or desirable to apply for, obtain and or maintain EDGAR Access Codes to be used on behalf of the undersigned for Electronic Filing of all Section 16(a) Securities and Exchange Act of 1934 filings; 2. execute for and on behalf of the undersigned, in the undersigneds capacity as an officer and/or director of CHF Solutions, Inc. the Company, Forms 3, 4 and 5 and any amendments thereto in accordance with Section 16(a) of the Securities Exchange Act of 1934 and the rules thereunder; 3. do and perform any and all acts for and on behalf of the undersigned which may be necessary or desirable to complete and execute any such Form 3, 4, or 5, complete and execute any amendment or amendments thereto, and timely file such form with the United States Securities and Exchange Commission and any stock exchange or similar authority; and 4. take any other action of any type whatsoever in connection with the foregoing which, in the opinion of such attorney in fact, may be of benefit to, in the best interest of, or legally required by, the undersigned, it being understood that the documents executed by such attorney in fact on behalf of the undersigned pursuant to this Power of Attorney shall be in such form and shall contain such terms and conditions as such attorney in fact may approve in such attorney in facts discretion. The undersigned hereby grants to each such attorney in fact full power and authority to do and perform any and every act and thing whatsoever requisite, necessary, or proper to be done in the exercise of any of the rights and powers herein granted, as fully to all intents and purposes as the undersigned might or could do if personally present, with full power of substitution or revocation, hereby ratifying and confirming all that such attorney in fact, or such attorney in facts substitute or substitutes, shall lawfully do or cause to be done by virtue of this power of attorney and the rights and powers herein granted. The undersigned acknowledges that the foregoing attorneys in fact, in serving in such capacity at the request of the undersigned, are not assuming, nor is the Company assuming, any of the undersigneds responsibilities to comply with Section 16 of the Securities Exchange Act of 1934. This Power of Attorney shall remain in full force and effect until the undersigned is no longer required to file Forms 3, 4 and 5 with respect to the undersigneds holdings of and transactions in securities issued by the Company, unless earlier revoked by the undersigned in a signed writing delivered to the foregoing attorneys in fact. IN WITNESS WHEREOF, the undersigned has caused this Power of Attorney to be executed as of this 13th day of April, 2021. Signature: /s/ Paul R. Wotta Print Name: Paul R. Wotta