0001209191-16-089928.txt : 20160106 0001209191-16-089928.hdr.sgml : 20160106 20160106170235 ACCESSION NUMBER: 0001209191-16-089928 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20160104 FILED AS OF DATE: 20160106 DATE AS OF CHANGE: 20160106 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: WHITE ROBERT S. CENTRAL INDEX KEY: 0001571208 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-36814 FILM NUMBER: 161327527 MAIL ADDRESS: STREET 1: 11625 26TH AVE. NORTH CITY: PLYMOUTH STATE: MN ZIP: 55441 4 1 doc4.xml FORM 4 SUBMISSION X0306 4 2016-01-04 0 0001374128 ENTELLUS MEDICAL INC ENTL 0001571208 WHITE ROBERT S. C/O ENTELLUS MEDICAL, INC. 3600 HOLLY LANE NORTH, SUITE 40 PLYMOUTH MN 55447 1 1 0 0 PRESIDENT & CEO Employee Stock Option (Right to Buy) 16.99 2016-01-04 4 A 0 135000 0.00 A 2026-01-04 Common Stock 135000 135000 D The option vests with respect to 1/48th of the shares beginning on February 4, 2016 (the first monthly anniversary of the vesting commencement date ("VCD")) and on each monthly anniversary of the VCD thereafter, subject to continued service through each applicable vesting date. /s/ Thomas E. Griffin, Attorney-in-Fact for Robert S. White 2016-01-05