0001209191-21-040072.txt : 20210611 0001209191-21-040072.hdr.sgml : 20210611 20210611201818 ACCESSION NUMBER: 0001209191-21-040072 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20210601 FILED AS OF DATE: 20210611 DATE AS OF CHANGE: 20210611 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Mead Dana G Jr. CENTRAL INDEX KEY: 0001222358 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-39562 FILM NUMBER: 211012914 MAIL ADDRESS: STREET 1: 2750 SAND HILL ROAD CITY: MENLO PARK STATE: CA ZIP: 94025 FORMER NAME: FORMER CONFORMED NAME: MEAD DANA G JR DATE OF NAME CHANGE: 20030310 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Pulmonx Corp CENTRAL INDEX KEY: 0001127537 STANDARD INDUSTRIAL CLASSIFICATION: SURGICAL & MEDICAL INSTRUMENTS & APPARATUS [3841] IRS NUMBER: 000000000 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 700 CHESAPEAKE DRIVE CITY: REDWOOD CITY STATE: CA ZIP: 94063 BUSINESS PHONE: 650-364-0400 MAIL ADDRESS: STREET 1: 700 CHESAPEAKE DRIVE CITY: REDWOOD CITY STATE: CA ZIP: 94063 FORMER COMPANY: FORMER CONFORMED NAME: PULMONX DATE OF NAME CHANGE: 20001031 4 1 doc4.xml FORM 4 SUBMISSION X0306 4 2021-06-01 0 0001127537 Pulmonx Corp LUNG 0001222358 Mead Dana G Jr. C/O PULMONX CORPORATION 700 CHESAPEAKE DRIVE REDWOOD CITY CA 94063 1 0 0 0 Common Stock 2021-06-01 4 A 0 2810 0.00 A 29125 D Common Stock 4076 I See footnote Represents grant of Restricted Stock Units payable solely in common stock of the Issuer that will vest on the one-year anniversary of the date of grant of June 1, 2021. The shares received as a liquidation distribution from KPCB XIII Associates, LLC, the managing member of Kleiner Perkins Caufield & Byers XIII, LLC, the direct holder of the shares as disclosed in prior reports. The shares are held directly by the Dana G. Mead, Jr. And D'Arcy Gage Mead, or Their Successors, as Trustees of The Mead Family Trust Created Uta Dated August 4, 1998, as Amended. /s/ Lauren Cristina, Attorney-in-Fact for Dana G. Mead Jr. 2021-06-11