SD 1 a17-14340_1sd.htm SD

 

 

UNITED STATES
SECURITIES AND EXCHANGE COMMISSION

Washington, D.C. 20549

 

FORM SD

 

Specialized Disclosure Report

 

CHF SOLUTIONS, INC.

(Exact name of registrant as specified in its charter)

 

Delaware

 

001-35312

 

No. 68-0533453

(State or other jurisdiction of incorporation)

 

(Commission File Number)

 

(I.R.S. Employer
Identification Number)

 

12988 Valley View Road, Eden Prairie, MN 55344

(Address of principal executive offices)(Zip code)

 

Gordon Weber (952) 345-4200

(Name and telephone number, including area code, of person to contact in connection with this report)

 

Check the appropriate box to indicate the rule pursuant to which this form is being filed, and provide the period to which the information in this form applies:

 

x         Rule 13p-1 under the Securities Exchange Act (17 CFR 240.13p-1) for the reporting period from January 1 to December 31, 2016.

 

 

 



 

Section 1 - Conflict Minerals Disclosure

 

Item 1.01 Conflict Minerals Disclosure and Report

 

This Form SD of CHF Solutions, Inc. (f/k/a Sunshine Heart, Inc.) (the “Company”) is filed pursuant to Rule 13p-1 promulgated under the Securities Exchange Act of 1934, as amended, for the reporting period January 1, 2016 to December 31, 2016.

 

A copy of the Company’s Conflict Minerals Report is provided as Exhibit 1.01 to this Form SD, and is publicly available in the Investor section of the Company’s website at www.chf-solutions.com, by selecting Financials and Filings under the Investors tab.

 

Item 1.02 Exhibit

 

A copy of the Company’s Conflict Minerals Report is provided as Exhibit 1.01 to this Form SD and incorporated herein by reference.

 

Section 2 - Exhibits

 

Item 2.01 Exhibits

 

The following exhibit is filed as part of this report.

 

Exhibit

 

Description

1.01

 

Conflict Minerals Report of CHF Solutions, Inc.

 

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SIGNATURES

 

Pursuant to the requirements of the Securities Exchange Act of 1934, the registrant has duly caused this report to be signed on its behalf by the duly authorized undersigned.

 

CHF SOLUTIONS, INC.

 

 

 

By:

/s/ Claudia Drayton

 

 

May 30, 2017

 

Claudia Drayton

 

 

(Date)

 

Chief Financial Officer

 

 

 

 

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Exhibit List

 

Exhibit

 

Description

1.01

 

Conflict Minerals Report of CHF Solutions, Inc.

 

4