CHF Solutions
CHF Solutions, Inc. (Form: 4, Received: 11/29/2017 16:56:03)
FORM 4
[ ] Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).         
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
                                                                                  
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Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 or Section 30(h) of the Investment Company Act of 1940
                      

1. Name and Address of Reporting Person *

ERB JOHN L
2. Issuer Name and Ticker or Trading Symbol

CHF Solutions, Inc. [ CHFS ]
5. Relationship of Reporting Person(s) to Issuer (Check all applicable)

__ X __ Director                      _____ 10% Owner
__ X __ Officer (give title below)      _____ Other (specify below)
CEO and President
(Last)          (First)          (Middle)

12988 VALLEY VIEW ROAD
3. Date of Earliest Transaction (MM/DD/YYYY)

11/22/2017
(Street)

EDEN PRAIRIE, MN 55344
(City)        (State)        (Zip)
4. If Amendment, Date Original Filed (MM/DD/YYYY)

 
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. Trans. Date 2A. Deemed Execution Date, if any 3. Trans. Code
(Instr. 8)
4. Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
5. Amount of Securities Beneficially Owned Following Reported Transaction(s)
(Instr. 3 and 4)
6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 7. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V Amount (A) or (D) Price

Table II - Derivative Securities Beneficially Owned ( e.g. , puts, calls, warrants, options, convertible securities)
1. Title of Derivate Security
(Instr. 3)
2. Conversion or Exercise Price of Derivative Security 3. Trans. Date 3A. Deemed Execution Date, if any 4. Trans. 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 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 of Derivative Security: Direct (D) or Indirect (I) (Instr. 4) 11. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V (A) (D) Date Exercisable Expiration Date Title Amount or Number of Shares
Series F Convertible Preferred Stock   $4.5   11/22/2017     P      100       11/22/2017     (1) Common Stock   22222     (2) 100   D    
Series 1 Warrant to Purchase Common Stock (right to buy)   $4.5   11/22/2017     P      100       11/22/2017   11/22/2018   Common Stock   22300     (2) 100   D    
Series 2 Warrant to Purchase Common Stock (right to buy)   $4.5   11/22/2017     P      100       11/22/2017   11/22/2024   Common Stock   22300     (2) 100   D    

Explanation of Responses:
(1)  The Series F Convertible Preferred Stock (the "Preferred Stock") has no expiration date.
(2)  The reporting person purchased the Preferred Stock for $995.54 per share in an underwritten public offering that closed on November 27, 2017. For each share of Preferred Stock purchased, the reporting person also received one warrant to purchase 223 shares of common stock (the Series 1 warrant), and one warrant to purchase 223 shares of common stock (the Series 2 warrant). The Preferred Stock and warrants were issued separately.

Reporting Owners
Reporting Owner Name / Address
Relationships
Director 10% Owner Officer Other
ERB JOHN L
12988 VALLEY VIEW ROAD
EDEN PRAIRIE, MN 55344
X
CEO and President

Signatures
Gayle C. Aiken, by Power of Attorney 11/29/2017
** 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.
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