0001235802-16-000255.txt : 20160615
0001235802-16-000255.hdr.sgml : 20160615
20160615165111
ACCESSION NUMBER: 0001235802-16-000255
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 2
CONFORMED PERIOD OF REPORT: 20160614
FILED AS OF DATE: 20160615
DATE AS OF CHANGE: 20160615
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: ENTELLUS MEDICAL INC
CENTRAL INDEX KEY: 0001374128
STANDARD INDUSTRIAL CLASSIFICATION: SURGICAL & MEDICAL INSTRUMENTS & APPARATUS [3841]
IRS NUMBER: 204627978
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 3600 HOLLY LANE NORTH
STREET 2: SUITE 40
CITY: PLYMOUTH
STATE: MN
ZIP: 55447
BUSINESS PHONE: 763-463-1595
MAIL ADDRESS:
STREET 1: 3600 HOLLY LANE NORTH
STREET 2: SUITE 40
CITY: PLYMOUTH
STATE: MN
ZIP: 55447
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: NEELS GUIDO J
CENTRAL INDEX KEY: 0001222362
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-36814
FILM NUMBER: 161715768
MAIL ADDRESS:
STREET 1: C/O GUIDANT CORP
STREET 2: 111 MONUMENT CIRCLE #2900
CITY: INDIANAPOLIS
STATE: IN
ZIP: 46204-5129
4
1
primary_doc.xml
PRIMARY DOCUMENT
X0306
4
2016-06-14
0
0001374128
ENTELLUS MEDICAL INC
ENTL
0001222362
NEELS GUIDO J
3600 HOLLY LANE NORTH, SUITE 40
PLYMOUTH
MN
55447
1
0
0
0
Common Stock, $0.001 par value
15000
D
Stock Option (right to buy)
18.26
2016-06-14
4
A
0
10000
0
A
2026-06-14
Common Stock
10000
10000
D
This option vests in full on the earlier to occur of June 14, 2017 and the date of the Company's annual meeting of stockholders following June 14, 2016, subject to the Reporting Person's continued service with the Company through the applicable vesting date.
/s/ Brent A. Moen, attorney-in-fact
2016-06-15
EX-24
2
poa-neels.txt
POWER OF ATTORNEY
Guido Neels
With respect to holdings of and transactions in
securities issued by Entellus Medical, Inc. (the
Company), the undersigned hereby constitutes and
appoints the officers and/or employees of the Company
listed on Schedule A attached hereto and as may be
amended from time to time, or any of them signing
singly, with full power of substitution and
resubstitution, to act as the undersigned's true
and lawful attorney-in-fact to:
1. prepare, execute in the undersigned's name
and on the undersigned's behalf, and submit to the
United States Securities and Exchange Commission
(the SEC) a Form ID, including amendments thereto,
and any other documents necessary or appropriate to
obtain and/or regenerate codes and passwords enabling
the undersigned to make electronic filings with the
SEC of reports required by Section 16(a) of the
Securities Exchange Act of 1934, as amended, Rule 144
under the Securities Act of 1933, as amended, or any
rule or regulation of the SEC;
2. execute for and on behalf of the undersigned,
Forms 3, 4, and 5 in accordance with Section 16 of
the Securities Exchange Act of 1934, as amended, any
Form 144 in accordance with Rule 144 under the
Securities Act of 1933, as amended, and the rules
and regulations thereunder;
3. do and perform any and all acts for and on
behalf of the undersigned which may be necessary
or desirable to complete and execute any such
Form 3, 4, or 5 or Form 144 or complete and execute
any amendment or amendments thereto, and timely file
such forms with the SEC and any stock exchange or
similar authority; and
4. take any other action of any type
whatsoever in connection with the foregoing which,
in the opinion of such attorney-in-fact, may be
of benefit to, in the best interest of, or legally
required by, the undersigned, it being understood
that the documents executed by such attorney-in-fact
on behalf of the undersigned pursuant to this Power
of Attorney shall be in such form and shall contain
such terms and conditions as such attorney-in-fact
may approve in the discretion of such attorney-in-
fact.
The undersigned hereby grants to each such attorney-
in-fact full power and authority to do and perform
any and every act and thing whatsoever requisite,
necessary, or proper to be done in the exercise of
any of the rights and powers herein granted, as fully
to all intents and purposes as the undersigned might
or could do if personally present, with full power of
substitution and resubstitution or revocation, hereby
ratifying and confirming all that such attorney-in-
fact, or such attorney-in-facts substitute or
substitutes, shall lawfully do or cause to be done
by virtue of this Power of Attorney and the rights
and powers herein granted.
The undersigned hereby acknowledges that the attorneys-
in-fact, in serving in such capacity at the request
of the undersigned, are not assuming, nor is the
Company assuming, any of the undersigned's
responsibilities to comply with Section 16 of the
Securities Exchange Act of 1934, as amended, or Rule
144 of the Securities Act of 1933, as amended, and
any similar law, rule or regulation.
This Power of Attorney shall remain in full force
and effect until the undersigned is no longer
required to file Forms 3, 4, and 5 and Forms 144
with respect to the undersigned's holdings of and
transactions in securities issued by the Company,
unless earlier revoked by the undersigned in a signed
writing delivered to the foregoing attorneys-in-fact.
IN WITNESS WHEREOF, the undersigned has caused
this Power of Attorney to be executed as of this
31st day of May, 2016.
/s/ Guido Neels
Guido Neels
Schedule A
Individuals Appointed as Attorney-in-Fact with
Full Power of Substitution and Resubstitution
1. Robert S. White, President and Chief Executive
Officer
2. Brent A. Moen, Chief Financial Officer and
Secretary
3. Jonelle Burnham, Senior Director Corporate
Compliance Counsel, Compliance Officer
4. Steve Sathre, Controller