0001209191-21-035934.txt : 20210526 0001209191-21-035934.hdr.sgml : 20210526 20210526163407 ACCESSION NUMBER: 0001209191-21-035934 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20210524 FILED AS OF DATE: 20210526 DATE AS OF CHANGE: 20210526 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: BASKETT FOREST CENTRAL INDEX KEY: 0001277631 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-39616 FILM NUMBER: 21966823 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Eargo, Inc. CENTRAL INDEX KEY: 0001719395 STANDARD INDUSTRIAL CLASSIFICATION: ORTHOPEDIC, PROSTHETIC & SURGICAL APPLIANCES & SUPPLIES [3842] IRS NUMBER: 273879804 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 1600 TECHNOLOGY DRIVE STREET 2: 6TH FLOOR CITY: SAN JOSE STATE: CA ZIP: 95110 BUSINESS PHONE: 650-351-7700 MAIL ADDRESS: STREET 1: 1600 TECHNOLOGY DRIVE STREET 2: 6TH FLOOR CITY: SAN JOSE STATE: CA ZIP: 95110 4 1 doc4.xml FORM 4 SUBMISSION X0306 4 2021-05-24 0 0001719395 Eargo, Inc. EAR 0001277631 BASKETT FOREST 1954 GREENSPRING DRIVE SUITE 600 TIMONIUM MD 21093 0 0 1 0 Common Stock 2021-05-24 4 J 0 2000000 0.00 D 4520019 I See Note 2 Common Stock 2021-05-24 4 J 0 30000 0.00 A 30000 I See Note 4 Common Stock 2021-05-24 4 J 0 30000 0.00 D 0 I See Note 4 Common Stock 2021-05-24 4 J 0 1629 0.00 A 1629 I See Note 7 New Enterprise Associates 15, L.P. ("NEA 15") made a pro rata distribution for no consideration of an aggregate of 2,000,000 shares of Common Stock of the Issuer to its general partner and its limited partners on May 24, 2021. The Reporting Person is a manager of NEA 15 GP, LLC ("NEA 15 GP"), which is the sole general partner of NEA Partners 15, L.P. ("NEA Partners 15"). NEA Partners 15 is the sole general partner of NEA 15, which is the direct beneficial owner of the shares. The Reporting Person disclaims beneficial ownership within the meaning of Section 16 of the Securities Exchange Act of 1934, as amended, or otherwise of such portion of the NEA 15 shares in which the Reporting Person has no pecuniary interest. NEA Partners 15 received 30,000 shares of Common Stock of the Issuer in the distribution by NEA 15 on May 24, 2021. The Reporting Person is a manager of NEA 15 GP, which is the sole general partner of NEA Partners 15, the direct beneficial owner of the shares. The Reporting Person disclaims beneficial ownership within the meaning of Section 16 of the Securities Exchange Act of 1934, as amended, or otherwise of such portion of the NEA Partners 15 shares in which the Reporting Person has no pecuniary interest. NEA Partners 15 made a pro rata distribution for no consideration of an aggregate of 30,000 shares of Common Stock of the Issuer to its limited partners on May 24, 2021. The Baskett-McKay Family Trust dtd 3/12/2014 (the "Baskett Trust") received 1,629 shares of Common Stock of the Issuer in the distribution by NEA Partners 15 on May 24, 2021. The Reporting Person is a trustee of the Baskett Trust, which is the direct beneficial owner of the shares. The Reporting Person disclaims beneficial ownership within the meaning of Section 16 of the Securities Exchange Act of 1934, as amended, or otherwise of such portion of the Baskett Trust shares in which the Reporting Person has no pecuniary interest. /s/ Sasha Keough, attorney-in-fact 2021-05-26