SEC Form 4 · accession 0001235802-17-000025
ENTELLUS MEDICAL INC · ENTL
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Jonelle R Burnham
Officer — Vice President & Gen'l Counsel
Period of report
Feb 4, 2017
Accepted (ET)
Feb 7, 2017 · 4:24 pm EST
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0001374128
Table I — non-derivative securities
| Security | Date | Code | Shares | Price | A/D | Owned after | D/I | Nature of ownership |
|---|---|---|---|---|---|---|---|---|
| Common Stock, $0.001 par valueF1 | Feb 4, 2017 | A | 20,000 | $0.00 | A | 20,000 | D |
Table II — derivative securities
| Security | Conv. / exercise price | Date | Code | Shares | A/D | Exercisable | Expires | Underlying | Underlying shares | Owned after | D/I |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Non-Statutory Stock Option (right to buy)F2 | $16.84 | Feb 4, 2017 | A | 40,000 | A | — | Feb 4, 2027 | Common Stock | 40,000 | 40,000 | D |
Explanation of responses
- F1These shares will be issued over time upon vesting pursuant to a restricted stock unit granted under the Entellus Medical, Inc. 2015 Incentive Award Plan.
- F2This option vests with respect to 1/48th of the shares on February 4, 2017 and on each monthly anniversary of February 4, 2017 thereafter, subject to such Reporting Person's continued employment with Entellus Medical, Inc.