Small Company Offering and Sale of Securities Without Registration (d)

Date : 11/21/2019 @ 10:19PM
Source : Edgar (US Regulatory)
Stock : CHF Solutions Inc (CHFS)
Quote : 0.47  0.0969 (25.97%) @ 4:00AM
CHF Solutions share price Chart
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Last $ 0.45 ▼ -0.02 (-4.26%)

Small Company Offering and Sale of Securities Without Registration (d)

o NoneEntity Type
0001506492
Sunshine Heart, Inc.
 
x Corporation
o Limited Partnership
o Limited Liability Company
o General Partnership
o Business Trust
o Other
Name of Issuer
 CHF Solutions, Inc.
Jurisdiction of Incorporation/Organization
DELAWARE
 
Year of Incorporation/Organization
  x Over Five Years Ago
  o Within Last Five Years (Specify Year)  
  o Yet to Be Formed 



2. Principal Place of Business and Contact Information
Name of Issuer 
 CHF Solutions, Inc. 
Street Address 1Street Address 2
 12988 VALLEY VIEW ROAD 
CityState/Province/CountryZIP/Postal CodePhone No. of Issuer
 EDEN PRAIRIE MINNESOTA 55344 952-345-4200 



3. Related Persons
Last NameFirst NameMiddle Name
ErbJohnL.
Street Address 1Street Address 2
12988 Valley View Road
CityState/Province/CountryZIP/Postal Code
Eden PrairieMINNESOTA55344
Relationship: x Executive Officer x Director o Promoter
Clarification of Response (if Necessary)
  

Last NameFirst NameMiddle Name
DraytonClaudia
Street Address 1Street Address 2
12988 Valley View Road
CityState/Province/CountryZIP/Postal Code
Eden PrairieMINNESOTA55344
Relationship: x Executive Officer o Director o Promoter
Clarification of Response (if Necessary)
  

Last NameFirst NameMiddle Name
BrandtSteve
Street Address 1Street Address 2
12988 Valley View Road
CityState/Province/CountryZIP/Postal Code
Eden PrairieMINNESOTA55344
Relationship: o Executive Officer x Director o Promoter
Clarification of Response (if Necessary)
  

Last NameFirst NameMiddle Name
CostanzoMariaRosa
Street Address 1Street Address 2
12988 Valley View Road
CityState/Province/CountryZIP/Postal Code
Eden PrairieMINNESOTA55344
Relationship: o Executive Officer x Director o Promoter
Clarification of Response (if Necessary)
  

 
Last NameFirst NameMiddle Name
SalvesonJon
Street Address 1Street Address 2
12988 Valley View Road
CityState/Province/CountryZIP/Postal Code
Eden PrairieMINNESOTA55344
Relationship: o Executive Officer x Director o Promoter
Clarification of Response (if Necessary)
  

Last NameFirst NameMiddle Name
WallerGregory
Street Address 1Street Address 2
12988 Valley View Road
CityState/Province/CountryZIP/Postal Code
Eden PrairieMINNESOTA55344
Relationship: o Executive Officer x Director o Promoter
Clarification of Response (if Necessary)
  

Last NameFirst NameMiddle Name
WatsonWarrenS.
Street Address 1Street Address 2
12988 Valley View Road
CityState/Province/CountryZIP/Postal Code
Eden PrairieMINNESOTA55344
Relationship: o Executive Officer x Director o Promoter
Clarification of Response (if Necessary)
  

 


4. Industry Group
o Agriculture Health Care o Retailing
 Banking & Financial Services   x Biotechnology o Restaurants
  o Commercial Banking   o Health Insurance Technology
  o Insurance  o Hospitals & Physicians  o Computers
  o Investing  o Pharmaceuticals  o Telecommunications
  o Investment Banking  o Other Health Care  o Other Technology
  o Pooled Investment Fund

    Travel
  o Other Banking & Financial Services o Manufacturing  o Airlines & Airports
 Real Estate  o Lodging & Conventions
  o Commercial  o Tourism & Travel Services
  o Construction  o Other Travel
  o REITS & Finance o Other
  o Residential 
  o Other Real Estate 
o Business Services 
 Energy 
  o Coal Mining 
  o Electric Utilities 
  o Energy Conservation 
  o Environmental Services 
  o Oil & Gas 
  o Other Energy 


5. Issuer Size
Revenue RangeAggregate Net Asset Value Range
o No Revenues o No Aggregate Net Asset Value
o $1 - $1,000,000 o $1 - $5,000,000
o $1,000,001 - $5,000,000 o $5,000,001 - $25,000,000
o $5,000,001 - $25,000,000 o $25,000,001 - $50,000,000
o $25,000,001 - $100,000,000 o $50,000,001 - $100,000,000
o Over $100,000,000 o Over $100,000,000
x Decline to Disclose o Decline to Disclose
o Not Applicable o Not Applicable


6. Federal Exemption(s) and Exclusion(s) Claimed (select all that apply)
o Rule 504(b)(1) (not (i), (ii) or (iii)) o Rule 505
o Rule 504 (b)(1)(i) x Rule 506(b)
o Rule 504 (b)(1)(ii) o Rule 506(c)
o Rule 504 (b)(1)(iii) o Securities Act Section 4(a)(5)
  o Investment Company Act Section 3(c)

7. Type of Filing
x New Notice Date of First Sale 2019-11-06 o First Sale Yet to Occur
o Amendment

8. Duration of Offering
Does the Issuer intend this offering to last more than one year? o Yes x No

9. Type(s) of Securities Offered (select all that apply)
o Pooled Investment Fund Interests x Equity
o Tenant-in-Common Securities o Debt
o Mineral Property Securities x Option, Warrant or Other Right to Acquire Another Security
x Security to be Acquired Upon Exercise of Option, Warrant or Other Right to Acquire Security o Other (describe)
  


10. Business Combination Transaction
Is this offering being made in connection with a business combination transaction, such as a merger, acquisition or exchange offer? o Yes x No
 
Clarification of Response (if Necessary) 
  

11. Minimum Investment
Minimum investment accepted from any outside investor$ 0 USD

12. Sales Compensation
RecipientRecipient CRD Number o None
 Ladenburg Thalmann & Co. Inc. 505
(Associated) Broker or Dealer x None(Associated) Broker or Dealer CRD Number x None
    
Street Address 1Street Address 2
 277 Park Avenue 26th Floor
City State/Province/CountryZIP/Postal Code
 New York NEW YORK 10172
State(s) of Solicitation x All States o Foreign/Non-US
 

 



13. Offering and Sales Amounts
Total Offering Amount $ 1365300 USD o Indefinite
Total Amount Sold $ 1365300 USD 
Total Remaining to be Sold $ 0 USD o Indefinite
 
Clarification of Response (if Necessary)
 Total offering amount includes the concurrent registered offering of common stock and excludes proceeds totaling up to $1,212,005 from the exercise of the warrants.


14. Investors
o Select if securities in the offering have been or may be sold to persons who do not qualify as accredited investors,
Number of such non-accredited investors who already have invested in the offering
 
  Regardless of whether securities in the offering have been or may be sold to persons who do not qualify as accredited investors, enter the total number of investors who already have invested in the offering: 3


15. Sales Commissions & Finders’ Fees Expenses
Provide separately the amounts of sales commissions and finders' fees expenses, if any. If the amount of an expenditure is not known, provide an estimate and check the box next to the amount.
Sales Commissions$ 109229 USD o Estimate
Finders' Fees$ 0 USD o Estimate
 
Clarification of Response (if Necessary)
  


16. Use of Proceeds
Provide the amount of the gross proceeds of the offering that has been or is proposed to be used for payments to any of the persons required to be named as executive officers, directors or promoters in response to Item 3 above. If the amount is unknown, provide an estimate and check the box next to the amount.
 $ 0 USD o

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