SEC Form 4 · accession 0001365916-17-000050
AMYRIS, INC. · AMRS
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
L John Doerr
Director
Period of report
Jun 6, 2017
Accepted (ET)
Jun 21, 2017 · 7:36 pm EDT
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0001365916
Table I — non-derivative securities
| Security | Date | Code | Shares | Price | A/D | Owned after | D/I | Nature of ownership |
|---|---|---|---|---|---|---|---|---|
| Common StockF2,F4 | Jun 6, 2017 | C | 869,173 | $15.00 | A | 869,173 | I | By Foris Ventures, LLC |
| Common StockF2 | holding | — | — | — | 2,134 | D | ||
| Common StockF2,F5 | holding | — | — | — | 9,648 | I | By Clarus, LLC | |
| Common StockF2,F6 | holding | — | — | — | 248,304 | I | By Kleiner Perkins Caufield & Byers XII, LLC | |
| Common StockF2,F7 | holding | — | — | — | 4,531 | I | By KPCB XII Founders Fund, LLC | |
| Common StockF2,F8 | holding | — | — | — | 567 | I | By The Vallejo Ventures Trust U/T/A 2/12/96 |
Table II — derivative securities
| Security | Conv. / exercise price | Date | Code | Shares | A/D | Exercisable | Expires | Underlying | Underlying shares | Owned after | D/I |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Series C Convertible Preferred StockF1,F4,F2,F3 | $15.00 | Jun 6, 2017 | C | 13,038 | D | Jun 6, 2017 | — | Common Stock | 869,173 | 0 | I |
Explanation of responses
- F1On 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.
- F2Reflects a 1-for-15 reverse stock split which became effective on June 5, 2017.
- F3Security automatically converted to Common Stock on June 6, 2017.
- F4The 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.
- F5The 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.
- F6The 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.
- F7The 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.
- F8The Reporting Person is a Trustee of The Vallejo Ventures Trust U/T/A 2/12/96.