0001209191-15-027172.txt : 20150317 0001209191-15-027172.hdr.sgml : 20150317 20150317174422 ACCESSION NUMBER: 0001209191-15-027172 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: KPCB XI Associates, LLC CENTRAL INDEX KEY: 0001500598 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-36545 FILM NUMBER: 15708063 BUSINESS ADDRESS: STREET 1: 2750 SAND HILL ROAD CITY: MENLO PARK STATE: CA ZIP: 94025 BUSINESS PHONE: 650-233-2750 MAIL ADDRESS: STREET 1: 2750 SAND HILL ROAD CITY: MENLO PARK STATE: CA ZIP: 94025 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: KLEINER PERKINS CAUFIELD & BYERS XI B LP CENTRAL INDEX KEY: 0001299254 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-36545 FILM NUMBER: 15708064 BUSINESS ADDRESS: STREET 1: 2750 SAND HILL ROAD CITY: MENLO PARK STATE: CA ZIP: 94025 BUSINESS PHONE: 6502332750 MAIL ADDRESS: STREET 1: 2750 SAND HILL ROAD CITY: MENLO PARK STATE: CA ZIP: 94025 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: KLEINER PERKINS CAUFIELD & BYERS XI-A LP CENTRAL INDEX KEY: 0001455502 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-36545 FILM NUMBER: 15708065 BUSINESS ADDRESS: STREET 1: 2750 SAND HILL ROAD CITY: MENLO PARK STATE: CA ZIP: 94025 BUSINESS PHONE: 650-233-2750 MAIL ADDRESS: STREET 1: 2750 SAND HILL ROAD CITY: MENLO PARK STATE: CA ZIP: 94025 4 1 doc4.xml FORM 4 SUBMISSION X0306 4 2015-03-13 0 0001271214 Intersect ENT, Inc. XENT 0001455502 KLEINER PERKINS CAUFIELD & BYERS XI-A LP C/O KLEINER PERKINS CAUFIELD & BYERS 2750 SAND HILL ROAD MENLO PARK CA 94025 0 0 1 0 0001299254 KLEINER PERKINS CAUFIELD & BYERS XI B LP 2750 SAND HILL ROAD MENLO PARK CA 94025 0 0 1 0 0001500598 KPCB XI Associates, LLC 2750 SAND HILL ROAD MENLO PARK CA 94025 0 0 1 0 Common Stock 2015-03-13 4 J 0 500000 0.00 D 2548589 I See footnote 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 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. Kleiner Perkins Caufield & Byers XI-A, L.P., By: KPCB XI Associates, LLC, Its General Partner, By: /s/ Paul M. Vronsky, General Counsel 2015-03-17 Kleiner Perkins Caufield & Byers XI-B, L.P., By: KPCB XI Associates, LLC, Its General Partner, By: /s/ Paul M. Vronsky, General Counsel 2015-03-12 KPCB XI Associates, LLC, By: /s/ Paul M. Vronsky, General Counsel 2015-03-12