SEC Form 4 · accession 0001235802-17-000106
ENTELLUS MEDICAL INC · ENTL
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Douglas Rohlen
Director
Period of report
Jul 14, 2017
Accepted (ET)
Jul 18, 2017 · 9:39 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 valueF1 | Jul 14, 2017 | A | 3,750 | $0.00 | A | 9,217 | D | |
| Common Stock, $0.001 par value | holding | — | — | — | 6,834 | I | Through D3DC, LLC | |
| Common Stock, $0.001 par value | holding | — | — | — | 20,299 | I | Through The Duke Rohlen and Kendall Simpson Rohlen, Trustees or Successor Trustee, Rohlen Rev Trust | |
| Common Stock, $0.001 par value | holding | — | — | — | 4,684 | I | Through The Rohlen 2013 Irrevocable Trust Agreement |
Table II — derivative securities
| Security | Conv. / exercise price | Date | Code | Shares | A/D | Exercisable | Expires | Underlying | Underlying shares | Owned after | D/I |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Stock Option (right to buy)F2 | $17.67 | Jul 14, 2017 | A | 7,500 | A | — | Jul 14, 2027 | Common Stock | 7,500 | 7,500 | D |
Explanation of responses
- F1Includes 3,750 shares that 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 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.