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*
Earnhardt Lisa D

(Last) (First) (Middle)
C/O INTERSECT ENT, INC.
1555 ADAMS DRIVE

(Street)
MENLO PARK CA 94025

(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
X Officer (give title below) Other (specify below)
See Remarks
5. If Amendment, Date of Original Filed (Month/Day/Year)
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)
Common Stock 724,868 D
Common Stock 26,182 I See Footnote(1)
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
Stock Option (right to buy) (2) 04/22/2023 Common Stock 89,375 $1.2 D
Stock Option (right to buy) (3) 04/22/2023 Common Stock 144,374 $1.2 D
Explanation of Responses:
1. Shares held in the name of Lisa Damkroger Earnhardt C/F Jack L. Earnhardt UTMA/CA Until Age 25 for the benefit of Reporting Person's son. Reporting Person disclaims beneficial ownership of these shares.
2. The shares subject to the option are immediately exercisable. 1/48th of the shares subject to the option shall vest monthly over four (4) years commencing on April 23, 2013. Registrant was initially granted an option to purchase 144,375 shares of which 55,000 shares have been exercised. The number of shares noted above reflect the balance of the shares not exercised and currently outstanding.
3. The shares subject to the option are immediately exercisable. 1/48th of the shares subject to the option shall vest monthly over four (4) years commencing on November 30, 2013.
Remarks:
President and Chief Executive Officer Exhibit List: Exhibit 24 - Power of Attorney
/s/ Lisa D. Earnhardt 07/23/2014
** 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.
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.