0001209191-19-058213.txt : 20191126 0001209191-19-058213.hdr.sgml : 20191126 20191126193239 ACCESSION NUMBER: 0001209191-19-058213 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20191122 FILED AS OF DATE: 20191126 DATE AS OF CHANGE: 20191126 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: 191252735 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 2019-11-22 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 2019-11-22 4 J 0 777506 0.00 A 2110839 I By trust Class A common stock 2019-11-22 4 J 0 12804 0.00 A 12804 I By trust Class A common stock 2019-11-22 4 J 0 32052 0.00 A 32052 I By partnership Class A common stock 2019-11-22 4 J 0 275918 0.00 A 275918 I By trust Class A common stock 2019-11-22 4 J 0 19255 0.00 A 19255 I By trust Class A common stock 2019-11-22 4 J 0 19255 0.00 A 19255 I By trust Class A common stock 12734 D Class B common stock 2019-11-22 4 J 0 46977 0.00 A Class A common stock 46977 721730 I Trust Pro rata distribution from KPCB Holdings, Inc. as nominee Held by Vallejo Ventures Trust, L. John and Ann Doerr, Trustees Held by the LJD Trust IX of which the reporting person is a trustee Held by LJD Ventures II Partnership of which the reporting person is a general partner Held by The 1999 Portico Trust of which reporting person is a trustee Held by The Hampton 1999 Trust dated May 25, 1999, of which reporting person is a trustee Held by The Austin 1999 Trust dated May 25, 1999, of which reporting person is a trustee Represents restricted stock units issued under the Bloom Energy Corporation 2018 Equity Incentive Plan. The RSUs will vest on the date of the next annual stockholders meeting, subject to continued service of the reporting person through such date. 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. Shawn Soderberg as attorney in fact for the reporting person 2019-11-26