0001788278-20-000001.txt : 20200108 0001788278-20-000001.hdr.sgml : 20200108 20200108150332 ACCESSION NUMBER: 0001788278-20-000001 CONFORMED SUBMISSION TYPE: 4/A PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20190903 FILED AS OF DATE: 20200108 DATE AS OF CHANGE: 20200108 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Costanzo Maria Rosa CENTRAL INDEX KEY: 0001788278 FILING VALUES: FORM TYPE: 4/A SEC ACT: 1934 Act SEC FILE NUMBER: 001-35312 FILM NUMBER: 20515513 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/A 1 primary_doc.xml PRIMARY DOCUMENT X0306 4/A 2019-09-03 2019-09-16 0 0001506492 CHF Solutions, Inc. CHFS 0001788278 Costanzo Maria Rosa 12988 VALLEY VIEW ROAD EDEN PRAIRIE MN 55344 1 0 0 0 Nonstatutory Stock Option 2.46 2019-09-03 4 J 0 1313 0 A 2029-09-02 Common Stock 1313 1313 D On January 6, 2020, the reporting person rejected the nonstatutory stock options granted to her on September 3, 2019. Accordingly, the reporting person disclaims beneficial ownership of these options of the Issuer's common stock issuable in connection therewith. This report shall not be deemed an admission that the reporting person is the beneficial owner of the securities for purposes of Section 16 or for any other purpose. Vests in 12 approximately equal consecutive monthly increments, commencing on the one-month anniversary of the date of grant, so that all of the options will be vested on the one-year anniversary of the date of grant. Thomas Lynch, by Power of Attorney 2020-01-08