SEC Form 4 · accession 0001235802-18-000030
ENTELLUS MEDICAL INC · ENTL
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Douglas Rohlen
Director
Period of report
Feb 28, 2018
Accepted (ET)
Mar 1, 2018 · 3:47 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 28, 2018 | D | 9,217 | $24.00 | D | 0 | D | |
| Common Stock, $0.001 par valueF1 | Feb 28, 2018 | D | 6,834 | $24.00 | D | 0 | I | Through D3DC, LLC |
| Common Stock, $0.001 par valueF1 | Feb 28, 2018 | D | 20,299 | $24.00 | D | 0 | I | Duke Rohlen and Kendall Simpson Rohlen, Trustees or Successor Trustee, of the Rohlen Rev Trust |
| Common Stock, $0.001 par valueF1 | Feb 28, 2018 | D | 4,684 | $24.00 | D | 0 | 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 | Feb 28, 2018 | D | 7,500 | D | — | Jul 14, 2027 | Common Stock | 7,500 | 0 | D |
Explanation of responses
- F1Disposed of pursuant to an Agreement and Plan of Merger, dated December 7, 2017, between Entellus Medical, Inc., Stryker Corporation and Explorer Merger Sub Corp. in exchange for a cash payment of $24.00 per share.
- F2This option, which provided for vesting in 12 equal quarterly installments commencing on July 14, 2017, was canceled in the merger in exchange for a cash payment equal to: (a) the number of shares of Issuer common stock underlying the option, multiplied by (b) the excess of $24.00 over the per share exercise price of such option.