SEC Form 4 · accession 0001235802-17-000104

ENTELLUS MEDICAL INC · ENTL

Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗

Reporting owner

Director

Period of report

Jul 14, 2017

Accepted (ET)

Jul 18, 2017 · 4:46 pm EDT

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 value^F1,F2	Jul 14, 2017	A	3,750	$0.00	A	3,750	D

Security	Conv. / exercise price	Date	Code	Shares	A/D	Exercisable	Expires	Underlying	Underlying shares	Owned after	D/I
Stock Option (right to buy)^F2,F3	$17.67	Jul 14, 2017	A	7,500	A	—	Jul 14, 2027	Common Stock	7,500	7,500	D

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.
F2Mr. Momtazee is an executive of Kohlberg Kravis Roberts & Co. L.P. (together, with its affiliates, "KKR"). Mr. Momtazee is required to transfer to KKR the economic benefits of his compensation received in connection with his service on the board of directors of the Issuer. Mr. Momtazee disclaims beneficial ownership over these securities, except to the extent of his pecuniary interest therein, if any, and the inclusion of these securities in this report shall not be deemed an admission of beneficial ownership for purposes of Section 16 of the Securities Exchange Act of 1934 or any other purpose.
F3This option vests with respect to 1/12th of the shares subject to the option on each quarterly anniversary of July 14, 2017 (the "Grant Date") occurring over the three-year period immediately following the Grant Date, subject to the Reporting Person's continued service with the Company through the applicable vesting date.