SEC Form 4 · accession 0001235802-17-000026
ENTELLUS MEDICAL INC · ENTL
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Thomas P. Williamson
Officer — Vice President, Sales
Period of report
Feb 4, 2017
Accepted (ET)
Feb 7, 2017 · 5:13 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,F2,F3 | Feb 4, 2017 | A | 20,000 | $0.00 | A | 37,033 | 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)F4 | $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.
- F2Includes 28,829 shares will be issued over time upon vesting pursuant to restricted stock units granted under the Entellus Medical, Inc. 2015 Incentive Award Plan.
- F3Includes an aggregate of 262 shares acquired under the Entellus Medical, Inc. 2015 Employee Stock Purchase Plan on June 30, 2016 and December 31, 2016.
- F4This option vests with respect to 1/48th of the shares on February 5, 2017 (the monthly anniversary of the promotion date) and on each monthly anniversary thereafter, subject to such Reporting Person's continued employment with Entellus Medical, Inc.