SEC Form 4
FORM 4 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP

Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934
or Section 30(h) of the Investment Company Act of 1940
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Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
1. Name and Address of Reporting Person*
DOERR L JOHN

(Last) (First) (Middle)
C/O AMYRIS, INC.
5885 HOLLIS STREET, SUITE 100

(Street)
EMERYVILLE CA 94608

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
AMYRIS, INC. [ AMRS ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director X 10% Owner
Officer (give title below) Other (specify below)
3. Date of Earliest Transaction (Month/Day/Year)
05/14/2019
4. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
X Form filed by One Reporting Person
Form filed by More than One Reporting Person
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
1. Title of Security (Instr. 3) 2. Transaction Date (Month/Day/Year) 2A. Deemed Execution Date, if any (Month/Day/Year) 3. Transaction Code (Instr. 8) 4. Securities Acquired (A) or Disposed Of (D) (Instr. 3, 4 and 5) 5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4) 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 7. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V Amount (A) or (D) Price
Common Stock 05/14/2019 J(1) 1,122,460 A $4.6 18,540,044(2) I By Foris Ventures, LLC(3)
Common Stock 5,532 D
Common Stock 9,648 I By Clarus, LLC(4)
Common Stock 248,304 I By Kleiner Perkins Caufield & Byers XII, LLC(5)
Common Stock 4,531 I By KPCB XII Founders Fund, LLC(6)
Common Stock 567 I By The Vallejo Ventures Trust U/T/A 2/12/96(7)
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 3) 2. Conversion or Exercise Price of Derivative Security 3. Transaction Date (Month/Day/Year) 3A. Deemed Execution Date, if any (Month/Day/Year) 4. Transaction Code (Instr. 8) 5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) 6. Date Exercisable and Expiration Date (Month/Day/Year) 7. Title and Amount of Securities Underlying Derivative Security (Instr. 3 and 4) 8. Price of Derivative Security (Instr. 5) 9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) 10. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 11. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V (A) (D) Date Exercisable Expiration Date Title Amount or Number of Shares
6.50% Convertible Senior Notes due 2019 $56.16 05/14/2019 J(1) $5,000,000 05/29/2014 05/15/2019 Common Stock 89,037 $5,000,000 $0 I By Foris Ventures, LLC(3)
Warrant (Right to Buy) $4.56 05/14/2019 J(1) 352,638 (8) 05/14/2021 Common Stock 352,638 $0 352,638 I By Foris Ventures, LLC(3)
Explanation of Responses:
1. On May 14, 2019, Foris Ventures, LLC ("Foris") exchanged $5,000,000 principal amount of the Issuer's 6.50% Convertible Senior Notes due 2019, including accrued and unpaid interest thereon, for 1,122,460 shares of common stock and a warrant to purchase 352,638 shares of common stock at an exercise price of $4.56 per share.
2. Pursuant to the Certificate of Designation for the Issuer's Series B 17.38% Convertible Preferred Stock ("Series B Preferred Stock"), the automatic conversion of the Series B Preferred Stock held by Foris to common stock is being held in abeyance to the extent such conversion would result in Foris beneficially owning in excess of 9.99% of the number of shares of common stock outstanding.
3. The Reporting Person indirectly holds all of the membership interests in Foris. The Reporting Person disclaims beneficial ownership of these securities except to the extent of his pecuniary interest therein.
4. The 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.
5. The 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.
6. The 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.
7. The Reporting Person is a Trustee of The Vallejo Ventures Trust U/T/A 2/12/96.
8. The exercisability of the warrant is subject to stockholder approval.
Remarks:
/s/ L. John Doerr by Stephen Dobson, Attorney-in-Fact 05/16/2019
** Signature of Reporting Person 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 4 (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).
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