0001209191-21-064767.txt : 20211116
0001209191-21-064767.hdr.sgml : 20211116
20211116163300
ACCESSION NUMBER: 0001209191-21-064767
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20211112
FILED AS OF DATE: 20211116
DATE AS OF CHANGE: 20211116
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: SANDELL SCOTT D
CENTRAL INDEX KEY: 0001237289
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-38598
FILM NUMBER: 211416571
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
FISCAL YEAR END: 1231
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
2021-11-12
0
0001664703
Bloom Energy Corp
BE
0001237289
SANDELL SCOTT D
1954 GREENSPRING DRIVE
SUITE 600
TIMONIUM
MD
21093
1
0
0
0
Class A Common Stock
2021-11-12
4
C
0
11963020
0.00
A
13296353
I
See Note 2
Class A Common Stock
2021-11-12
4
J
0
13296353
0.00
D
0
I
See Note 2
Class A Common Stock
2021-11-12
4
J
0
3246531
0.00
A
3246531
I
See Note 5
Class A Common Stock
2021-11-12
4
J
0
3246531
0.00
D
0
I
See Note 5
Class A Common Stock
2021-11-12
4
J
0
109450
0.00
A
109450
I
See Note 8
Class A Common Stock
53686
D
Class B Common Stock
2021-11-12
4
C
0
11963020
0.00
D
Class A Common Stock
11963020
0
I
See Note 2
New Enterprise Associates 10, Limited Partnership ("NEA 10") converted 11,963,020 shares of Class B Common Stock at its option, resulting in its acquisition of 11,963,020 shares of Class A Common Stock.
The Reporting Person is the general partner of NEA Partners 10, Limited Partnership ("NEA Partners 10"). NEA Partners 10 is the sole general partner of NEA 10, the direct beneficial owner of the securities. The Reporting Person disclaims beneficial ownership within the meaning of Section 16 of the Securities Exchange Act of 1934, as amended, or otherwise of such portion of the securities held by NEA 10 in which the Reporting Person has no pecuniary interest.
NEA 10 made a pro rata distribution for no consideration of an aggregate of 13,296,353 shares of Class A Common Stock of the Issuer to its general partner and limited partners on November 12, 2021.
NEA Partners 10 received 3,246,531 shares of Class A Common Stock of the Issuer in the distribution by NEA 10 on November 12, 2021.
The Reporting Person is the general partner of NEA Partners 10, the direct beneficial owner of the securities. The Reporting Person disclaims beneficial ownership within the meaning of Section 16 of the Securities Exchange Act of 1934, as amended, or otherwise of such portion of the securities held by NEA Partners 10 in which the Reporting Person has no pecuniary interest.
NEA Partners 10 made a pro rata distribution for no consideration of an aggregate of 3,246,531 shares of Class A Common Stock of the Issuer to its limited partners on November 12, 2021.
The Reporting Person, as trustee of the Blue Mountain Trust, dated April 29, 2019 (the "Blue Mountain Trust"), received 109,450 shares of Class A Common Stock of the Issuer in the distribution by NEA Partners 10 on November 12, 2021.
The Reporting Person is the trustee of the Blue Mountain Trust, which is the direct beneficial owner of the securities. The Reporting Person disclaims beneficial ownership within the meaning of Section 16 of the 1934 Act, as amended, or otherwise of such portion of the securities held by the Blue Mountain Trust in which the Reporting Person has no pecuniary interest.
The Class B common stock is convertible into the Issuer's Class A common stock on a 1-for-1 basis at the holder's option or upon any transfer except for certain permitted transfers. All the outstanding shares of the Issuer's 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 the closing of Issuer's IPO, (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 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 Issuer's 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.
/s/ Sasha Keough, attorney-in-fact
2021-11-16