SEC Form 5
FORM 5 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

ANNUAL STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP

Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934
or Section 30(h) of the Investment Company Act of 1940
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Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
  
Form 3 Holdings Reported.
X
Form 4 Transactions Reported.
1. Name and Address of Reporting Person*
Hart Charles A

(Last) (First) (Middle)
19345 RHINESTONE STREET NW

(Street)
ANOKA MN 55303

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
BIOHEART, INC. [ BHRT.OB ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director 10% Owner
Officer (give title below) Other (specify below)
3. Statement for Issuer's Fiscal Year Ended (Month/Day/Year)
12/31/2011
4. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
X Form filed by One Reporting Person
Form filed by More than One Reporting Person
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
1. Title of Security (Instr. 3) 2. Transaction Date (Month/Day/Year) 2A. Deemed Execution Date, if any (Month/Day/Year) 3. Transaction Code (Instr. 8) 4. Securities Acquired (A) or Disposed Of (D) (Instr. 3, 4 and 5) 5. Amount of Securities Beneficially Owned at end of Issuer's Fiscal Year (Instr. 3 and 4) 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 7. Nature of Indirect Beneficial Ownership (Instr. 4)
Amount (A) or (D) Price
Common Stock 12/15/2011 P4 2,200,000 A $0.03 3,583,050 D
Common Stock 423,870 I by spouse
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 3) 2. Conversion or Exercise Price of Derivative Security 3. Transaction Date (Month/Day/Year) 3A. Deemed Execution Date, if any (Month/Day/Year) 4. Transaction Code (Instr. 8) 5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) 6. Date Exercisable and Expiration Date (Month/Day/Year) 7. Title and Amount of Securities Underlying Derivative Security (Instr. 3 and 4) 8. Price of Derivative Security (Instr. 5) 9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) 10. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 11. Nature of Indirect Beneficial Ownership (Instr. 4)
(A) (D) Date Exercisable Expiration Date Title Amount or Number of Shares
Warrant (right to buy) $0.03 12/15/2011 4A 2,200,000 05/15/2012 12/15/2022 Commom Stock 2,200,000 $0 2,969,110 D
Warrant (right to buy) $0.59 10/01/2009 04/01/2012 Common Stock 183,672 2,969,110 D
Warrant (right to buy) $0.68 10/16/2009 04/16/2012 Common Stock 26,316 2,969,110 D
Warrant (right to buy) $0.82 11/14/2009 05/14/2012 Common Stock 22,059 2,969,110 D
Warrant (right to buy) $0.18 05/30/2011 11/30/2013 Common Stock 90,310 2,969,110 D
Warrant (right to buy) $0.18 06/13/2011 12/13/2013 Common Stock 337,790 2,969,110 D
Warrant (right to buy) $0.65 09/16/2010 03/16/2013 Common Stock 2,160 418,830 I By Spouse
Warrant (right to buy) $0.64 02/21/2010 08/21/2012 Common Stock 108,963 2,969,110 D
Warrant (right to buy) $0.06 01/06/2012 07/06/2014 Common Stock 416,670 418,830 I By Spouse
Stock Option (right to buy) $0.68 02/10/2010 02/10/2020 Common Stock 20,000 570,000 D
Stock Option (right to buy) $0.92 11/05/2009 11/05/2019 Common Stock 50,000 570,000 D
Stock Option (right to buy) $0.21 08/12/2011 08/12/2021 Common Stock 40,000 570,000 D
Stock Option (right to buy) $0.07 08/29/2011 08/29/2021 Common Stock 460,000 570,000 D
Explanation of Responses:
Catherine Sulawske-Guck (attorney-in-fact) 01/19/2012
** Signature of Reporting Person Date
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
* If the form is filed by more than one reporting person, see Instruction 4 (b)(v).
** Intentional misstatements or omissions of facts constitute Federal Criminal Violations See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure.
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number.