0001209191-20-048860.txt : 20200831
0001209191-20-048860.hdr.sgml : 20200831
20200831202011
ACCESSION NUMBER: 0001209191-20-048860
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20200827
FILED AS OF DATE: 20200831
DATE AS OF CHANGE: 20200831
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: 201153086
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: 4353 NORTH FIRST STREET
CITY: SAN JOSE
STATE: CA
ZIP: 95134
BUSINESS PHONE: 408-543-1500
MAIL ADDRESS:
STREET 1: 4353 NORTH FIRST STREET
CITY: SAN JOSE
STATE: CA
ZIP: 95134
4
1
doc4.xml
FORM 4 SUBMISSION
X0306
4
2020-08-27
0
0001664703
Bloom Energy Corp
BE
0001032455
DOERR L JOHN
4353 NORTH FIRST STREET
SAN JOSE
CA
95134
1
0
0
0
Class A Common Stock
2020-08-27
4
C
0
7701219
0.00
A
7701219
I
KPCB Holdings, Inc. as Nominee
Class A Common Stock
2020-08-27
4
J
0
7701219
0.00
D
0
I
KPCB Holdings, Inc. as Nominee
Class A Common Stock
2020-08-27
4
J
0
929374
0.00
A
3040213
I
By trust
Class A Common Stock
2020-08-27
4
J
0
17534
0.00
A
17534
I
KPTV, LLC
Class A Common Stock
2020-08-27
4
J
0
8769
0.00
A
8769
I
2750 Sand Hill Associates, LLC
Class A Common Stock
32547
D
Class A Common Stock
32052
I
By partnership
Class A Common Stock
275918
I
By trust
Class A Common Stock
19255
I
By trust
Class A Common Stock
19255
I
By trust
Class B Common Stock
2020-08-27
4
C
0
7701219
0.00
D
Class A Common Stock
7701219
159115
I
KPCB Holdings, Inc. as Nominee
Class B Common Stock
2020-08-27
4
J
0
159115
0.00
D
Class A Common Stock
159115
0
I
KPCB Holdings, Inc. as Nominee
Class B Common Stock
2020-08-27
4
J
0
159115
0.00
A
Class A Common Stock
159115
739275
I
By trust
Conversion of a derivative security in accordance with its terms.
All shares are held for convenience in the name of KPCB Holdings, Inc., as nominee, for the accounts of such individuals and entities who each exercise their own voting and dispositive control over such shares.
KPCB X Associates, LLC ("KPCB X Associates"), is the general partner of Kleiner Perkins Caufield & Byers X-A, L.P. ("KPCB X-A") and Kleiner Perkins Caufield & Byers X-B, L.P. ("KPCB X-B"). Brook Byers, L. John Doerr, Kevin Compton, Doug Mackenzie, Raymond Lane and Theodore Schlein, the managers of KPCB X Associates, share voting and dispositive control over the shares held by KPCB X-A and KPCB X-B. Each manager of KPCB X Associates disclaims beneficial ownership of the shares held by KPCB X-A and KPCB X-B.
Represents a pro-rata in-kind distribution of Class A Common Stock of the Issuer by KPCB X-A and KPCB X-B without consideration to their partners (the "Fund Distribution") and a change in the form of beneficial ownership for individuals and entities associated with KPCB Holdings, Inc.
Represents a change in the form of ownership by virtue of the receipt of shares in the Fund Distribution.
Held by Vallejo Ventures Trust, L. John and Ann Doerr, Trustees.
Held by KPTV, LLC, of which Vallejo Ventures Trust is the sole member.
Held by 2750 Sand Hill Associates, LLC, of which KPTV, LLC is a member.
Held by LJD Ventures II Partnership, of which the Reporting Person is a general partner.
Held by The 1999 Portico Trust, of which the Reporting Person is a trustee.
Held by The Hampton 1999 Trust dated May 25, 1999, of which the Reporting Person is a trustee.
Held by The Austin 1999 Trust dated May 25, 1999, of which the Reporting Person is a trustee.
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 of the Issuer or Chairman of the Issuer's Board to so convert all shares of Class B Common Stock, or (iv) immediately following the date of the death of KR Sridhar.
Represents a change in the form of beneficial ownership of Class B Common Stock for individuals and entities associated with KPCB Holdings, Inc., as nominee.
/s/ Shawn Soderberg, attorney-in-fact
2020-08-31