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