0001596771-15-000061.txt : 20150813 0001596771-15-000061.hdr.sgml : 20150813 20150813104937 ACCESSION NUMBER: 0001596771-15-000061 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20150811 FILED AS OF DATE: 20150813 DATE AS OF CHANGE: 20150813 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Sunshine Heart, 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 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: BUCKMAN PAUL CENTRAL INDEX KEY: 0001215243 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-35312 FILM NUMBER: 151049297 MAIL ADDRESS: STREET 1: 12988 VALLEY VIEW RD CITY: EDEN PRAIRIE STATE: MN ZIP: 55402 4 1 primary_doc.xml PRIMARY DOCUMENT X0306 4 2015-08-11 0 0001506492 Sunshine Heart, Inc. SSH 0001215243 BUCKMAN PAUL 12988 VALLEY VIEW RD EDEN PRAIRIE MN 55344 1 0 0 0 Common Stock 2015-08-11 4 P 0 10000 2.55 A 24012 D Non-qualified Stock Option (right to buy) 6.23 2021-08-17 Common Stock 11685 11685 D On September 23, 2014, the Board supplemented the Option Agreement for the insider to denominate the option exercise currency as US Dollars rather than Australian Dollars as originally denominated upon issuance. The options were originally reported on Form 3 in US currency, as converted from the Australian Dollar amount of the exercise price. The option vested as to 1/48th of the shares each month with (i) 5 months vesting on August 18, 2011 and (ii) the remaining shares vesting equally for 43 consecutive months beginning September 17, 2011. Gayle C. Aiken, by Power of Attorney 2015-08-13