0001365916-17-000050.txt : 20170621 0001365916-17-000050.hdr.sgml : 20170621 20170621193618 ACCESSION NUMBER: 0001365916-17-000050 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20170606 FILED AS OF DATE: 20170621 DATE AS OF CHANGE: 20170621 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: AMYRIS, INC. CENTRAL INDEX KEY: 0001365916 STANDARD INDUSTRIAL CLASSIFICATION: INDUSTRIAL ORGANIC CHEMICALS [2860] IRS NUMBER: 000000000 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 5885 HOLLIS ST SUITE 100 CITY: EMERYVILLE STATE: CA ZIP: 94608 BUSINESS PHONE: 510-450-0761 MAIL ADDRESS: STREET 1: 5885 HOLLIS ST SUITE 100 CITY: EMERYVILLE STATE: CA ZIP: 94608 FORMER COMPANY: FORMER CONFORMED NAME: AMYRIS BIOTECHNOLOGIES INC DATE OF NAME CHANGE: 20060613 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: 001-34885 FILM NUMBER: 17923792 MAIL ADDRESS: STREET 1: C/O KLEINER PERKINS CAUFIELD & BYERS STREET 2: 2750 SAND HILL ROAD CITY: MENLO PARK STATE: CA ZIP: 94025 4 1 edgar.xml PRIMARY DOCUMENT X0306 4 2017-06-06 0001365916 AMYRIS, INC. AMRS 0001032455 DOERR L JOHN C/O AMYRIS, INC. 5885 HOLLIS STREET, SUITE 100 EMERYVILLE CA 94608 1 0 0 0 Common Stock 2017-06-06 4 C 0 869173 15.00 A 869173 I By Foris Ventures, LLC Common Stock 2134 D Common Stock 9648 I By Clarus, LLC Common Stock 248304 I By Kleiner Perkins Caufield & Byers XII, LLC Common Stock 4531 I By KPCB XII Founders Fund, LLC Common Stock 567 I By The Vallejo Ventures Trust U/T/A 2/12/96 Series C Convertible Preferred Stock 15.00 2017-06-06 4 C 0 13037.586 1000.00 D 2017-06-06 Common Stock 869173 0 I By Foris Ventures, LLC On June 6, 2017, the stated value of the Reporting Person's Series C Convertible Preferred Stock automatically converted to Common Stock at a conversion price of $15.00 per share upon the Issuer effecting a 1-for-15 reverse stock split. Reflects a 1-for-15 reverse stock split which became effective on June 5, 2017. Security automatically converted to Common Stock on June 6, 2017. The Reporting Person indirectly holds all of the membership interests in Foris Ventures, LLC. The Reporting Person disclaims beneficial ownership of these securities except to the extent of his pecuniary interest therein. The Reporting Person is the manager of Clarus, LLC. The Reporting Person disclaims beneficial ownership of these securities except to the extent of his pecuniary interest therein. The shares are held for convenience in the name of "KPCB Holdings, Inc., as nominee" for the account of entities affiliated with Kleiner Perkins Caufield & Byers and others. KPCB Holdings, Inc. has no voting, dispositive or pecuniary interest in any such shares. The Managing Member of Kleiner Perkins Caufield & Byers XII, LLC is KPCB XII Associates, LLC, of which the Reporting Person is the managing member. The Reporting Person disclaims beneficial ownership of these securities except to the extent of his pecuniary interest therein.The shares are held for convenience in the name of "KPCB Holdings, Inc., as nominee" for the account of entities affiliated with Kleiner Perkins Caufield & Byers and others. KPCB Holdings, Inc. has no voting, dispositive or pecuniary interest in any such shares. The Managing Member of KPCB XII Founders Fund, LLC is KPCB XII Associates, LLC, of which the Reporting Person is the managing member. The Reporting Person disclaims beneficial ownership of these securities except to the extent of his pecuniary interest therein.The shares are held for convenience in the name of "KPCB Holdings, Inc., as nominee" for the account of entities affiliated with Kleiner Perkins Caufield & Byers and others. KPCB Holdings, Inc. has no voting, dispositive or pecuniary interest in any such shares. The Reporting Person is a Trustee of The Vallejo Ventures Trust U/T/A 2/12/96. /s/ L. John Doerr by Stephen Dobson, Attorney-in-Fact 2017-06-21