0001209191-18-044627.txt : 20180731
0001209191-18-044627.hdr.sgml : 20180731
20180731201452
ACCESSION NUMBER: 0001209191-18-044627
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20180727
FILED AS OF DATE: 20180731
DATE AS OF CHANGE: 20180731
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: DOERR L JOHN
CENTRAL INDEX KEY: 0001032455
STATE OF INCORPORATION: CA
FISCAL YEAR END: 1231
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-38598
FILM NUMBER: 18982601
MAIL ADDRESS:
STREET 1: C/O KLEINER PERKINS CAUFIELD & BYERS
STREET 2: 2750 SAND HILL ROAD
CITY: MENLO PARK
STATE: CA
ZIP: 94025
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: Bloom Energy Corp
CENTRAL INDEX KEY: 0001664703
STANDARD INDUSTRIAL CLASSIFICATION: ELECTRICAL INDUSTRIAL APPARATUS [3620]
IRS NUMBER: 770565408
STATE OF INCORPORATION: DE
BUSINESS ADDRESS:
STREET 1: 1299 ORLEANS DRIVE
CITY: SUNNYVALE
STATE: CA
ZIP: 94089
BUSINESS PHONE: 408-543-1500
MAIL ADDRESS:
STREET 1: 1299 ORLEANS DRIVE
CITY: SUNNYVALE
STATE: CA
ZIP: 94089
4
1
doc4.xml
FORM 4 SUBMISSION
X0306
4
2018-07-27
0
0001664703
Bloom Energy Corp
BE
0001032455
DOERR L JOHN
1299 ORLEANS DRIVE
SUNNYVALE
CA
94089
1
0
0
0
8% Convertible Preferred Note (Series G)
2018-07-27
4
C
0
16703
0.00
D
Class B Common Stock
16703
0
I
Vallejo Ventures Trust
Class B Common Stock
2018-07-27
4
C
0
16703
0.00
A
Class A Common Stock
16703
674753
I
Vallejo Ventures Trust
The principal amount and accrued interest of the 8% Convertible Preferred Notes ("8% Notes") automatically converted into the specified number of shares of Class B Common Stock as a result of the automatic conversion of Issuer's outstanding preferred stock in connection with the Issuer's IPO.
The number of shares reflect both the principal and the interest accrued on the 8% Notes through July 27, 2018, the date of the automatic conversion in connection with the Issuer's IPO.
The Class B Common Stock is convertible into the Issuer's Class A Common Stock on a 1-for-1 basis (a) at the holder's option; or (b) upon any transfer except certain permitted transfers. All the outstanding shares of Class B Common Stock will convert automatically into shares of Class A common stock upon the date that is the earliest to occur of (i) immediately prior to the close of business on the fifth anniversary of July 27, 2018, (ii) immediately prior to the close of business on the date on which the outstanding shares of Class B Common Stock represent less than five percent (5%) of the aggregate number of shares of Class A Common Stock and Class B Common Stock then outstanding, (iii) the date and time, or the occurrence of an event, specified in a written conversion election delivered by KR Sridhar to the Secretary or Chairman of the Board to so convert all shares of Class B Common Stock, or (iv) immediately following the date of the death of KR Sridhar.
L. John Doerr and Ann Doerr, Trustees of the Vallejo Ventures Trust.
Two of two Forms 4 being filed to report transactions by the reporting person occurring on July 27, 2018. The holdings for KPCB Holdings, Inc., as nominee are reported on Form 1 of 2.
/s/Shawn Soderberg, attorney-in-fact
2018-07-31