- Amended Statement of Ownership (SC 13G/A)
February 14 2012 - 1:58PM
Edgar (US Regulatory)
UNITED STATES
SECURITIES AND EXCHANGE COMMISSION
Washington, DC 20549
SCHEDULE 13G
Under the Securities Exchange Act of 1934
(Amendment No. 1)*
(Name of Issuer)
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Class A Common Stock, $0.0001 par value per share
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(Title of Class of Securities)
(CUSIP Number)
(Date of Event Which Requires Filing of this Statement)
Check the appropriate box to designate the rule pursuant to which this Schedule is filed:
¨
Rule 13d-1(b)
¨
Rule 13d-1(c)
x
Rule 13d-1(d)
*
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The remainder of this cover page shall be filled out for a reporting persons initial filing on this form with respect to the subject class of securities, and for
any subsequent amendment containing information which would alter the disclosures provided in a prior cover page.
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The
information required in the remainder of this cover page shall not be deemed to be filed for the purpose of Section 18 of the Securities Exchange Act of 1934 (Act) or otherwise subject to the liabilities of that section of
the Act but shall be subject to all other provisions of the Act (however, see the Notes).
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
control number.
Page 1 of 7
pages
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1.
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Names of Reporting Persons.
Kishore V. Seendripu, Ph.D.
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2.
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Check the Appropriate Box if a
Member of a Group (See Instructions)
(a)
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(b)
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3.
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SEC Use Only
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4.
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Citizenship or Place of
Organization
United States
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Number of
Shares
Beneficially
Owned by
Each
Reporting
Person
With:
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5.
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Sole Voting Power
503,891 shares of Class A Common Stock
(1)
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6.
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Shared Voting Power
3,737,774 shares of Class A Common Stock
(2)
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7.
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Sole Dispositive Power
503,891 shares of Class A Common Stock
(1)
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8.
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Shared Dispositive Power
3,737,774 shares of Class A Common Stock
(2)
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9.
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Aggregate Amount Beneficially Owned by Each Reporting Person
4,241,665 shares of Class A Common Stock (3)
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10.
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Check if the Aggregate Amount in
Row (9) Excludes Certain Shares (See Instructions)
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11.
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Percent of Class Represented by
Amount in Row (9)
18.6 % (4)
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12.
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Type of Reporting Person (See
Instructions)
IN
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(1)
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Consists of 18,920 shares of Class B Common Stock held of record by the Seendripu Relatives Trust (Relatives Trust), 178,979 shares of Class B Common Stock
held of record by the Kishore V. Seendripu Annuity Trust (Kishore Trust) and 178,979 shares of Class B Common Stock held of record by the Rekha S. Seendripu Annuity Trust (Rekha Trust). Kishore V. Seendripu, Ph.D., a member
of the Issuers board of directors and named executive officer, is a trustee of the Relatives Trust, the Kishore Trust and the Rekha Trust. Includes options to purchase 127,013 shares of Class B Common Stock, which will be exercisable within 60
days of January 1, 2012. Each share of Class B Common Stock is convertible into one share of Class A Common Stock, which is publicly traded stock, upon certain transfers and at the option of the holder. On the seventh anniversary of the closing of
the Issuers initial public offering (March 29, 2017), the Class B Common Stock and the Class A Common Stock will automatically convert into a single class of Common Stock.
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(2)
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Consists of 3,737,774 shares of Class B Common Stock held of record by the Seendripu Family Trust (Family Trust). Kishore V. Seendripu,
Ph.D., a member of the Issuers board of directors and named executive officer, is a trustee of the Family Trust. Rekha Seendripu, Kishore V. Seendripus spouse, is a trustee of the Family Trust. Each share of Class B Common Stock is
convertible into one share of Class A Common Stock, which is publicly traded stock, upon certain transfers and at the option of the holder. On the seventh anniversary of the closing of the Issuers initial public offering (March 29,
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Page 2 of 7
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2017), the Class B Common Stock and the Class A Common Stock will automatically convert into a single class of Common Stock.
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(3)
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Represents 4,241,665 shares of Class B Common Stock. Each share of Class B Common Stock is convertible into one share of Class A Common Stock, which is publicly traded
stock, upon certain transfers and at the option of the holder. On the seventh anniversary of the closing of the Issuers initial public offering (March 29, 2017), the Class B Common Stock and the Class A Common Stock will automatically convert
into a single class of Common Stock.
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(4)
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The approximate percentages of Class A Common Stock outstanding as of October 21, 2011, as reported in the Issuers Report on Form 10-Q for the quarterly period
ended September 30, 2011, plus the aggregate number of shares of Class A Common Stock beneficially owned by the Reporting Person.
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Page 3 of 7
pages
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Item 1.
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(a
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Name of Issuer:
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MaxLinear, Inc.
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(b
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Address of Issuers Principal Executive Offices:
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2051 Palomar Airport Road
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Suite 100
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Carlsbad, California 92011
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Item 2.
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(a
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Name of Person Filing:
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Kishore V. Seendripu, Ph.D.
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(b
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Address of Principal Business Office or, if none, Residence:
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Kishore V. Seendripu, Ph.D.
c/o MaxLinear, Inc.
2051 Palomar Airport Road,
Suite 100
Carlsbad, California 92011
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(c
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Citizenship:
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United States
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(d
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Title of Class of Securities:
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Class B Common Stock, $0.0001 par value per share (1)
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(1
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)
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Represents 4,241,665 shares of Class B Common Stock. Each share of Class B Common Stock is convertible into one share of Class A Common Stock, which is publicly traded stock, upon
certain transfers and at the option of the holder. On the seventh anniversary of the closing of the Issuers initial public offering (March 29, 2017), the Class B Common Stock and the Class A Common Stock will automatically convert into a
single class of Common Stock.
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(e
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CUSIP Number:
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57776J 100
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Item 3.
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If this statement is filed pursuant to Rules 13d-1(b), or 13d-2(b) or (c), check whether the person filing is a:
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(a
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Broker or dealer registered under
section 15 of the Act (15 U.S.C. 78o).
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(b
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Bank as defined in section 3(a)(6) of
the Act (15 U.S.C. 78c).
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(c
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Insurance company as defined in
section 3(a)(19) of the Act (15 U.S.C. 78c).
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(d
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Investment company registered under
section 8 of the Investment Company Act of 1940 (15 U.S.C. 80a-8).
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(e
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An investment advisor in accordance
with §240.13d-1(b)(1)(ii)(E);
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(f
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An employee benefit plan or endowment
fund in accordance with §240.13d-1(b)(1)(ii)(F);
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(g
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A parent holding company or control
person in accordance with §240.13d-1(b)(1)(ii)(G);
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(h
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A savings associations as defined in
Section 3(b) of the Federal Deposit Insurance Act (12 U.S.C. 1813);
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(i
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A church plan that is excluded from
the definition of an investment company under section 3(c)(14) of the Investment Company Act of 1940 (15 U.S.C. 80a-3);
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(j
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Group, in accordance with
§240.13d-1(b)(1)(ii)(J).
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Page 4 of 7
pages
Item 4. Ownership.
The following information with respect to the ownership of the Class B Common Stock by the Reporting Persons filing this statement on Schedule 13G is provided as of December 31, 2011.
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(a)
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Amount Beneficially Owned:
4,241,665 (1)
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(b)
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Percent of Class:
18.6% (2)
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(c)
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Number of shares as to which such persons have:
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(i)
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Sole power to vote or to direct the vote:
503,891 (3)
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(ii)
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Shared power to vote or to direct the vote:
3,737,774 (4)
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(iii)
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Sole power to dispose or to direct the disposition of:
503,891 (3)
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(iv)
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Shared power to dispose or to direct the disposition of:
3,737,774 (4)
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(1)
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Represents 4,241,665 shares of Class B Common Stock. Each share of Class B Common Stock is convertible into one share of Class A Common Stock, which is publicly
traded stock, upon certain transfers and at the option of the holder. On the seventh anniversary of the closing of the Issuers initial public offering (March 29, 2017), the Class B Common Stock and the Class A Common Stock will
automatically convert into a single class of Common Stock.
|
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(2)
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The approximate percentages of Class A Common Stock outstanding as October 21, 2011, as reported in the Issuers Report on Form 10-Q for the quarterly
period ended September 30, 2011, plus the aggregate number of shares of Class A Common Stock beneficially owned by the Reporting Person.
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(3)
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Consists of 18,920 shares of Class B Common Stock held of record by the Seendripu Relatives Trust (Relatives Trust), 178,979 shares of Class B Common Stock
held of record by the Kishore V. Seendripu Annuity Trust (Kishore Trust) and 178,979 shares of Class B Common Stock held of record by the Rekha S. Seendripu Annuity Trust (Rekha Trust). Kishore V. Seendripu, Ph.D., a member
of the Issuers board of directors and named executive officer, is a trustee of the Relatives Trust, the Kishore Trust and the Rekha Trust. Includes options to purchase 127,013 shares of Class B Common Stock, which will be exercisable within 60
days of January 1, 2012. Each share of Class B Common Stock is convertible into one share of Class A Common Stock, which is publicly traded stock, upon certain transfers and at the option of the holder. On the seventh anniversary of the
closing of the Issuers initial public offering (March 29, 2017), the Class B Common Stock and the Class A Common Stock will automatically convert into a single class of Common Stock.
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(4)
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Consists of 3,737,774 shares of Class B Common Stock held of record by the Seendripu Family Trust (Family Trust). Kishore V. Seendripu, Ph.D., a member of
the Issuers board of directors and named executive officer, is a trustee of the Family Trust. Rekha Seendripu, Kishore V. Seendripus spouse, is a trustee of the Family Trust. Each share of Class B Common Stock is convertible into one
share of Class A Common Stock, which is publicly traded stock, upon certain transfers and at the option of the holder. On the seventh anniversary of the closing of the Issuers initial public offering (March 29, 2017), the Class B Common
Stock and the Class A Common Stock will automatically convert into a single class of Common Stock.
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Item 5.
Ownership of Five Percent or Less of a Class.
If this statement is being filed to report the fact that as of the date
hereof the reporting person has ceased to be the beneficial owner of more than five percent of the class of securities, check the following
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Item 6. Ownership of More than Five Percent on Behalf of Another Person.
Not applicable.
Item 7.
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Identification and Classification of the Subsidiary Which Acquired the Security Being Reported on By the Parent Holding Company or Control Person.
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Not applicable.
Item 8. Identification and Classification of Members of the Group.
Not applicable.
Page 5 of 7
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Item 9. Notice of Dissolution of Group.
Not applicable.
Item 10. Certifications.
Not applicable.
Page 6 of 7
pages
SIGNATURE
After reasonable inquiry and to the best of my knowledge and belief, I certify that the information set forth in this statement is true, complete and correct.
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February 13, 2012
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Date
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By: /s/ Kishore V. Seendripu, Ph.D.
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Print Name: Kishore V. Seendripu, Ph.D.
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Page 7 of 7
pages
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