0001235802-17-000160.txt : 20171018 0001235802-17-000160.hdr.sgml : 20171018 20171018192051 ACCESSION NUMBER: 0001235802-17-000160 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20171016 FILED AS OF DATE: 20171018 DATE AS OF CHANGE: 20171018 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: MENSINK KEVIN L CENTRAL INDEX KEY: 0001626343 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-36814 FILM NUMBER: 171143484 MAIL ADDRESS: STREET 1: C/O ENTELLUS MEDICAL, INC. STREET 2: 3600 HOLLY LANE NORTH, SUITE 40 CITY: PLYMOUTH STATE: MN ZIP: 55447 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 4 1 primary_doc.xml PRIMARY DOCUMENT X0306 4 2017-10-16 0 0001374128 ENTELLUS MEDICAL INC ENTL 0001626343 MENSINK KEVIN L C/O ENTELLUS MEDICAL, INC. 3600 HOLLY LANE NORTH, SUITE 40 PLYMOUTH MN 55447 0 1 0 0 VP Marketing Common Stock, $0.001 par value 2017-10-16 4 M 0 10000 1.24 A 17500 D Common Stock, $0.001 par value 2017-10-16 4 S 0 10000 18.2903 D 7500 D Stock Option (right to buy) 1.24 2017-10-16 4 M 0 10000 1.24 D 2023-04-08 Common Stock 10000 61400 D Includes 7,500 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. These shares were sold under a pre-arranged sales plan pursuant to Rule 10b5-1 under the Securities Exchange Act of 1934, as amended. The price reported in Column 4 is a weighted average price. These shares were sold in multiple transactions at prices ranging from $18.25 to $18.64, inclusive. The reporting person undertakes to provide to Entellus Medical, Inc., any security holder of Entellus Medical, Inc., or the staff of the Securities and Exchange Commission, upon request, full information regarding the number of shares sold at each separate price within the ranges set forth in this footnote (3) to this Form 4. This option vested as to twenty-five percent (25%) of the shares underlying the option on April 8, 2014, with the remaining shares vesting in 36 substantially equal monthly installments on each monthly anniversary of the grant date thereafter, subject to continued employment or service with the Issuer through each applicable vesting date. /s/ Brent Moen, attorney-in-fact 2017-10-18