SEC Form 3
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*
Fletcher Mark J

(Last) (First) (Middle)
710 MEDTRONIC PARKWAY
C/O MEDTRONIC, INC.

(Street)
MINNEAPOLIS MN 55432-5604

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
07/23/2014
3. Issuer Name and Ticker or Trading Symbol
Intersect ENT, Inc. [ XENT ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director 10% Owner
Officer (give title below) Other (specify below)
5. If Amendment, Date of Original Filed (Month/Day/Year)
07/28/2014
6. Individual or Joint/Group Filing (Check Applicable Line)
X Form filed by One Reporting Person
Form filed by More than One Reporting Person
Table I - Non-Derivative Securities Beneficially Owned
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)
No securities beneficially owned.(1) 0 D
Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
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
Explanation of Responses:
1. On July 28, 2014, Reporting Person reported on a Form 3 an indirect beneficial ownership of shares of Series C Convertible Preferred Stock and Series D Convertible Preferred Stock of Issuer held by Medtronic, Inc. Reporting Person is the President of Surgical Technologies of Medtronic, Inc. Pursuant to safe harbor set forth in Rule 16a-1(a)(2)(iii), Reporting Person is not deemed to have a pecuniary interest in the securities held by Medtronic, Inc., and therefore, was not required to report the indirect beneficial ownership of the shares held by Medtronic, Inc. As of July 23, 2014, the Reporting Person did not beneficially own any shares of Issuer.
/s/ Mark Fletcher 10/02/2014
** 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.
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