0001209191-15-041968.txt : 20150512 0001209191-15-041968.hdr.sgml : 20150512 20150512194714 ACCESSION NUMBER: 0001209191-15-041968 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20150511 FILED AS OF DATE: 20150512 DATE AS OF CHANGE: 20150512 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: 15856131 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 2015-05-11 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 2015-05-11 4 J 0 800000 0.00 D 1748589 I See footnote Common Stock 2015-05-11 4 J 0 1285 0.00 A 2891 D Shares disposed of by way of distribution to the respective partners 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 partnership agreement and to those individuals and entities associated with Kleiner Perkins Caufield & Byers for whom shares are held for convenience in the name of "KPCB Holdings, Inc. as nominee." Shares beneficially owned consist of (a) 1,532,929 shares held by KPCB XI-A, (b) 36,255 shares held by KPCB XI-B, and (c) 179,405 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 partners of KPCB XI-A described in footnote 1. /s/ Dana G. Mead, Jr. 2015-05-12