0001235802-17-000084.txt : 20170614 0001235802-17-000084.hdr.sgml : 20170614 20170614170007 ACCESSION NUMBER: 0001235802-17-000084 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20170613 FILED AS OF DATE: 20170614 DATE AS OF CHANGE: 20170614 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: 17911711 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 2017-06-13 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 2017-06-13 4 A 0 2500 0 A 17500 D Stock Option (right to buy) 13.38 2017-06-13 4 A 0 5000 0 A 2027-06-13 Common Stock 5000 5000 D Includes 2,500 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. This option vests in full on the earlier to occur of June 13, 2018 and the date of the Company's annual meeting of stockholders immediately following June 13, 2017, subject to the Reporting Person's continued service with the Company through the applicable vesting date. /s/ Jonelle R. Burnham, attorney-in-fact 2017-06-14