SEC FORM 3/A SEC Form 3
FORM 3 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES

Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934
or Section 30(h) of the Investment Company Act of 1940
 
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1. Name and Address of Reporting Person*
O'Dwyer Donal

(Last) (First) (Middle)
12988 VALLEY VIEW ROAD

(Street)
EDEN PRAIRIE MN 55344

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
02/14/2012
3. Issuer Name and Ticker or Trading Symbol
Sunshine Heart, Inc. [ SSH ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director 10% Owner
Officer (give title below) Other (specify below)
5. If Amendment, Date of Original Filed (Month/Day/Year)
02/14/2012
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 Beneficially Owned
1. Title of Security (Instr. 4) 2. Amount of Securities Beneficially Owned (Instr. 4) 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 4. Nature of Indirect Beneficial Ownership (Instr. 5)
Common Stock 686(1) D
Common Stock 10,370 I Family Trust(2)
Common Stock 38,791 I Pension Trust(3)
Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 4) 2. Date Exercisable and Expiration Date (Month/Day/Year) 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) 4. Conversion or Exercise Price of Derivative Security 5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 6. Nature of Indirect Beneficial Ownership (Instr. 5)
Date Exercisable Expiration Date Title Amount or Number of Shares
Employee Stock Option (right to buy) (4) 07/05/2014 Common Stock 485 101.74 D
Employee Stock Option (right to buy) (5) 08/17/2021 Common Stock 11,200 7.1218 D
Common Stock Warrant (right to buy) (6) 12/08/2014 Common Stock 9,150 6.5114 D
Explanation of Responses:
1. This Form 3 amends the number of securities directly beneficially owned by the reporting person.
2. Dundrum Investments P/I is the trustee and the reporting person's spouse has the authority to change the trustee.
3. The reporting person and his spouse jointly have the power to make investment and voting decisions.
4. Fully vested.
5. This Form 3 amends the vesting schedule of this option. The option vests as to 1/48 of the shares each month with (i) 5 months of shares vesting on August 18, 2011 and (ii) the remaining shares vesting equally for 43 consecutive months commencing September 17, 2011.
6. Immediately exercisable.
/s/ Jeffrey Mathiesen, Chief Financial Officer 05/02/2012
** 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 5 (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.
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number.