X0204 3 2012-02-14 0 0001506492 Sunshine Heart, Inc. SSH 0001542840 CM Capital LEVEL 9 545 QUEEN ST. BRISBANE C3 QLD 4000 AUSTRALIA 0 0 1 0 0001542841 CM Capital Venture 4A A/C LEVEL 9 545 QUEEN ST. BRISBANE C3 QLD 4000 AUSTRALIA 0 0 1 0 0001542842 CM Capital Venture 4B A/C LEVEL 9 545 QUEEN ST. BRISBANE C3 QLD 4000 AUSTRALIA 0 0 1 0 Common Stock 750356 I By CM Capital Venture 4A A/C Common Stock 750356 I By CM Capital Venture 4B A/C Employee Stock Option (right to buy) 6.5114 2014-12-08 Common Stock 169643 I By CM Capital Venture 4A A/C Employee Stock Option (right to buy) 6.5114 2014-12-08 Common Stock 169643 I By CM Capital Venture 4B A/C Common Stock Warrant (right to buy) 6.5114 2014-12-08 Common Stock 187500 I By CM Capital Venture 4A A/C Common Stock Warrant (right to buy) 6.5114 2014-12-08 Common Stock 187500 I By CM Capital Venture 4B A/C Represents securities held directly by CM Capital Venture 4A A/C. CM Capital Venture 4A A/C is a fund affiliated with CM Capital Investments Pty Ltd. Mr. Mark Harvey, a director of the Issuer, shares voting and investment power with other partners and may be deemed to be a beneficial owner of the reported securities. Mr. Harvey disclaims indirect beneficial ownership of the reported securities except to the extent of his pecuniary interest. This report shall not be deemed an admission that Mr. Harvey is the beneficial owner of such securities for purposes of Section 16 or for any other purpose. Represents securities held directly by CM Capital Venture 4B A/C. CM Capital Venture 4B A/C is a fund affiliated with CM Capital Investments Pty Ltd. Mr. Mark Harvey, a director of the Issuer, shares voting and investment power with other partners and may be deemed to be a beneficial owner of the reported securities. Mr. Harvey disclaims indirect beneficial ownership of the reported securities except to the extent of his pecuniary interest. This report shall not be deemed an admission that Mr. Harvey is the beneficial owner of such securities for purposes of Section 16 or for any other purpose. The option vests as to 1/48th of the shares per month beginning November 2, 2012 until fully vested. Immediately exercisable. /s/ Kassendra D. Galindo, attorney-in-fact 2012-02-28 s/ Kassendra D. Galindo, attorney-in-fact 2012-02-28 s/ Kassendra D. Galindo, attorney-in-fact 2012-02-28