0001209191-15-027174.txt : 20150317
0001209191-15-027174.hdr.sgml : 20150317
20150317174509
ACCESSION NUMBER: 0001209191-15-027174
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20150313
FILED AS OF DATE: 20150317
DATE AS OF CHANGE: 20150317
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: Intersect ENT, Inc.
CENTRAL INDEX KEY: 0001271214
STANDARD INDUSTRIAL CLASSIFICATION: SURGICAL & MEDICAL INSTRUMENTS & APPARATUS [3841]
IRS NUMBER: 200280837
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 1555 ADAMS DRIVE
CITY: MENLO PARK
STATE: CA
ZIP: 94025
BUSINESS PHONE: 650-641-2100
MAIL ADDRESS:
STREET 1: 1555 ADAMS DRIVE
CITY: MENLO PARK
STATE: CA
ZIP: 94025
FORMER COMPANY:
FORMER CONFORMED NAME: SINEXUS INC
DATE OF NAME CHANGE: 20031124
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: 001-36545
FILM NUMBER: 15708070
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
4
1
doc4.xml
FORM 4 SUBMISSION
X0306
4
2015-03-13
0
0001271214
Intersect ENT, Inc.
XENT
0001222358
Mead Dana G Jr.
C/O KLEINER PERKINS CAUFIELD & BYERS
2750 SAND HILL ROAD
MENLO PARK
CA
94025
1
0
1
0
Common Stock
2015-03-13
4
J
0
500000
0.00
D
2548589
I
See footnote
Common Stock
2015-03-13
4
J
0
803
0.00
A
1606
D
Shares disposed of by way of distribution to the respective members of each of Kleiner Perkins Caufield & Byers XI-A, L.P. ("KPCB XI-A") and Kleiner Perkins Caufield & Byers XI-B, L.P. ("KPCB XI-B") pro rata and without consideration, in accordance with each such entity's operating agreement and to those individuals and entities associated with Kleiner Perkins Caufield & Byers for whom such shares are held for convenience in the name of "KPCB Holdings, Inc. as nominee."
Shares beneficially owned consist of (a) 2,234,842 shares held by KPCB XI-A, (b) 52,262 shares held by KPCB XI-B, and (c) 261,485 shares held by individuals and entities associated with Kleiner Perkins Caufield & Byers. All shares are held for convenience in the name of "KPCB Holdings, Inc. as nominee," for the accounts of such individuals and entities who each exercise their own voting and dispositive power over such shares. The general partner of KPCB XI-A and KPCB XI-B is KPCB XI Associates, LLC. Brook H. Byers, L. John Doerr, Raymond J. Lane and Theodore E. Schlein, the managers of KPCB XI Associates, LLC, exercise shared voting and dispositive power over the shares directly held by KPCB XI-A and KPCB XI-B.
Shares acquired by the Reporting Person in connection with the distribution of such shares to the members of KPCB XI-A described in footnote 1.
/s/ Dana G. Mead, Jr.
2015-03-17