FORM 3
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF
SECURITIES
OMB APPROVAL
OMB Number: 3235-0104 Estimated average burden hours per response... 0.5
Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 or Section 30(h) of the
Investment Company Act of 1940
1. Name and Address of Reporting Person * | 2. Date of Event Requiring | 3. Issuer Name and Ticker or Trading Symbol | ||||||
Statement (MM/DD/YYYY) | ||||||||
KPCB X ASSOCIATES LLC | 7/24/2018 | Bloom Energy Corp [BE] | ||||||
(Last) | (First) | (Middle) | 4. Relationship of Reporting Person(s) to Issuer (Check all applicable) | |||||
2750 SAND HILL ROAD | _____ Director | ___X___ 10% Owner | ||||||
_____ Officer (give title below) | _____ Other (specify below) | |||||||
(Street) | 5. If Amendment, Date | 6. Individual or Joint/Group Filing(Check Applicable Line) | ||||||
MENLO PARK, CA 94025 | Original Filed(MM/DD/YYYY) | |||||||
7/26/2018 | ___ Form filed by One Reporting Person | |||||||
_X_ Form filed by More than One Reporting Person | ||||||||
(City) | (State) | (Zip) | ||||||
Table I - Non-Derivative Securities Beneficially Owned | ||||||||
1.Title of Security | 2. Amount of Securities | 3. Ownership | 4. Nature of Indirect Beneficial Ownership | |||||
(Instr. 4) | Beneficially Owned | Form: Direct | (Instr. 5) | |||||
(Instr. 4) | (D) or Indirect | |||||||
(I) | ||||||||
(Instr. 5) | ||||||||
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivate Security | 2. Date Exercisable | 3. Title and Amount of Securities | 4. Conversion | 5. Ownership | 6. Nature of Indirect | ||
(Instr. 4) | and Expiration Date | Underlying Derivative Security | or Exercise | Form of | Beneficial Ownership | ||
(MM/DD/YYYY) | (Instr. 4) | Price of | Derivative | (Instr. 5) | |||
Derivative | Security: | ||||||
Date | Expiration | Title | Amount or | ||||
Security | Direct (D) or | ||||||
Exercisable | Date | Number of | |||||
Indirect (I) | |||||||
Shares | |||||||
(Instr. 5) | |||||||
Class B | |||||||
6% Convertible Note | Common | 1231400 (3)(4) | $0 (1) | I | See Footnote (5)(6)(7) | ||
Stock (2) |
Explanation of Responses:
- Upon the completion of the Issuer's IPO, the outstanding principal and accrued interest on the 6% Convertible Notes ("6% Notes") will be convertible at any time at the option of the holders thereof into shares of Issuer's Class B Common Stock.
- 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 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 (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.
- The number of shares reflect both the principal and the interest accrued through July 24, 2018.
- The number of shares of Class B Common Stock that the 6% Notes are convertible into, as of the time of the filing, was incorrectly reported in the Reporting Persons' original Form 3 filed on July 26, 2018. This amended filing correctly reflects the number of shares of Class B Common Stock that the 6% Notes were convertible into through July 24, 2018.
- 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 IX Associates, LLC ("KPCB IX Associates"), is the general partner of KPCB IX-A and KPCB IX-B. KPCB X Associates, LLC ("KPCB X Associates"), is the general partner of KPCB X-A and KPCB X-B. Brook Byers, L. John Doerr, Kevin Compton, Doug Mackenzie, Raymond Lane and Theodore Schlein, the managers of KPCB IX Associates, share voting and dispositive control over the shares held by KPCB IX-A and KPCB IX-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 IX Associates and KPCB X Associates disclaims beneficial
ownership of the shares held by KPCB IX-A, KPCB IX-B, KPCB X-A and KPCB X-B except to the extent of its pecuniary interest therein.
- Consists of (a) 478,645 shares of Class B Common Stock issuable upon conversion of the 6% Notes held by KPCB IX-A; (b) 14,777 shares of Class B Common Stock issuable upon conversion of the 6% Notes held by KPCB IX-B; (c) 421,324 shares of Class B Common Stock issuable upon conversion of the 6% Notes held by KPCB X-A; (d) 11,883 shares of Class B Common Stock issuable upon conversion of the 6% Notes held by KPCB X-B; and (e) 304,771 shares of Class B Common Stock issuable upon conversion of the 6% Notes held by individuals and entities associated with Kleiner Perkins Caufield & Byers.
Reporting Owners
Reporting Owner Name / Address | Relationships | |
Director | 10% OwnerOfficerOther | |
KPCB X ASSOCIATES LLC | ||
2750 SAND HILL ROAD | X | |
MENLO PARK, CA 94025 | ||
KPCB IX ASSOCIATES LLC | ||
2750 SAND HILL ROAD | X | |
MENLO PARK, CA 94025 | ||
KLEINER PERKINS CAUFIELD & BYERS X B LP | ||
2750 SAND HILL ROAD | X | |
MENLO PARK, CA 94025 | ||
KLEINER PERKINS CAUFIELD & BYERS IX A LP | ||
2750 SAND HILL RD | X | |
MENLO PARK, CA 94025 | ||
KLEINER PERKINS CAUFIELD & BYERS IX B LP | ||
2750 SAND HILL RD | X | |
MENLO PARK, CA 94025 | ||
KLEINER PERKINS CAUFIELD & BYERS X A LP | ||
2750 SAND HILL ROAD | X | |
MENLO PARK, CA 94025 |
Signatures
/s/ Susan Biglieri, Chief Financial Officer of KPCB X Associates, LLC
**Signature of Reporting Person
/s/ Susan Biglieri, Chief Financial Officer of KPCB IX Associates, LLC
**Signature of Reporting Person
/s/ Susan Biglieri, Chief Financial Officer of KPCB IX Associates, LLC, General Partner of Kleiner Perkins Caufield & Byers IX- A, L.P.
**Signature of Reporting Person
/s/ Susan Biglieri, Chief Financial Officer of KPCB IX Associates, LLC, General Partner of Kleiner Perkins Caufield & Byers IX- B, L.P.
**Signature of Reporting Person
/s/ Susan Biglieri, Chief Financial Officer of KPCB X Associates, LLC, General Partner of Kleiner Perkins Caufield & Byers X-A, L.P.
**Signature of Reporting Person
/s/ Susan Biglieri, Chief Financial Officer of KPCB X Associates, LLC, General Partner of Kleiner Perkins Caufield & Byers X-B, L.P.
**Signature of Reporting Person
11/22/2019
Date
11/22/2019
Date
11/22/2019
Date
11/22/2019
Date
11/22/2019
Date
11/22/2019
Date
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
- If the form is filed by more than one reporting person, see Instruction 5(b)(v).
- Intentional misstatements or omissions of facts constitute Federal Criminal Violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure.
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB control number.
Attachments
- Original document
- Permalink
Disclaimer
Bloom Energy Corporation published this content on 22 November 2019 and is solely responsible for the information contained therein. Distributed by Public, unedited and unaltered, on 23 November 2019 03:02:01 UTC