FORM 3 |
UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 or Section 30(h) of the Investment Company Act of 1940 |
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1. Name and Address of Reporting Person*
(Street)
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2. Date of Event Requiring Statement
(Month/Day/Year) 10/29/2018 |
3. Issuer Name and Ticker or Trading Symbol
Intersect ENT, Inc. [ XENT ] |
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4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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5. If Amendment, Date of Original Filed
(Month/Day/Year) |
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6. Individual or Joint/Group Filing (Check Applicable Line)
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Table I - Non-Derivative Securities Beneficially Owned | |||
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1. Title of Security (Instr. 4) | 2. Amount of Securities Beneficially Owned (Instr. 4) | 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) | 4. Nature of Indirect Beneficial Ownership (Instr. 5) |
Common Stock | 36,203(1) | D |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||
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1. Title of Derivative Security (Instr. 4) | 2. Date Exercisable and Expiration Date (Month/Day/Year) | 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) | 4. Conversion or Exercise Price of Derivative Security | 5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) | 6. Nature of Indirect Beneficial Ownership (Instr. 5) | ||
Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||
Stock Options (Right to buy) | (2) | 02/28/2028 | Common Stock | 21,000 | $35.9 | D | |
Stock Options (Right to buy) | (3) | 01/20/2025 | Common Stock | 25,000 | $21.06 | D | |
Stock Options (Right to buy) | (4) | 01/14/2026 | Common Stock | 25,000 | $18.9 | D | |
Stock Options (Right to buy) | (5) | 01/17/2027 | Common Stock | 24,500 | $13.05 | D | |
Stock Options (Right to buy) | (6) | 04/22/2023 | Common Stock | 10,938 | $1.2 | D |
Explanation of Responses: |
1. Includes 8,033 Restricted Stock Units. Each restricted stock unit represents a right to receive one share of Intersect ENT, Inc. common stock upon vesting. 3,266 units vest on March 1, 2019, 3,267 units vest on March 1, 2020 and 1,500 units vest on March 1, 2021. |
2. The vesting commencement date of the option is March 1, 2018. 1/8th of the shares subject to the option shall vest on September 1, 2018 and 1/48th of the shares subject to the option shall vest monthly thereafter over 42 months. |
3. The vesting commencement date of the option is January 21, 2015. 1/8th of the shares subject to the option shall vest on July 21, 2015 and 1/48th of the shares subject to the option shall vest monthly thereafter over 42 months. |
4. The shares subject to the option vest monthly over four years commencing on January 1, 2016. |
5. The vesting commencement date of the option is March 1, 2017. 1/8th of the shares subject to the option shall vest on September 1, 2017 and 1/48th of the shares subject to the option shall vest monthly thereafter over 42 months. |
6. The shares subject to the option vest monthly over four years commencing on April 23, 2013. |
Remarks: |
/s/ David A. Lehman, Attorney-in-Fact for Stimson Susan P | 11/07/2018 | |
** Signature of Reporting Person | Date | |
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | ||
* If the form is filed by more than one reporting person, see Instruction 5 (b)(v). | ||
** Intentional misstatements or omissions of facts constitute Federal Criminal Violations See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). | ||
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure. | ||
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number. |