Statement of Changes in Beneficial Ownership (4)
August 12 2019 - 06:22PM
Edgar (US Regulatory)
FORM 4
[ ]
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue.
See
Instruction 1(b).
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
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OMB APPROVAL
OMB Number:
3235-0287
Estimated average burden
hours per response...
0.5
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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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1. Name and Address of Reporting Person
*
Sridhar KR
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2. Issuer Name
and
Ticker or Trading Symbol
Bloom Energy Corp
[
BE
]
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
_____ Director
_____ 10% Owner
__
X
__ Officer (give title below)
_____ Other (specify below)
President, CEO
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(Last)
(First)
(Middle)
4353 NORTH FIRST STREET
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3. Date of Earliest Transaction
(MM/DD/YYYY)
8/8/2019
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(Street)
SAN JOSE, CA 95134
(City)
(State)
(Zip)
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4. If Amendment, Date Original Filed
(MM/DD/YYYY)
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6. Individual or Joint/Group Filing
(Check Applicable Line)
_
X
_ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person
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Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
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1.Title of Security
(Instr. 3)
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2. Trans. Date
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2A. Deemed Execution Date, if any
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3. Trans. Code
(Instr. 8)
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4. Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
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5. Amount of Securities Beneficially Owned Following Reported Transaction(s)
(Instr. 3 and 4)
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6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)
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7. Nature of Indirect Beneficial Ownership (Instr. 4)
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Code
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V
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Amount
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(A) or (D)
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Price
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Table II - Derivative Securities Beneficially Owned (
e.g.
, puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security
(Instr. 3)
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2. Conversion or Exercise Price of Derivative Security
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3. Trans. Date
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3A. Deemed Execution Date, if any
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4. Trans. Code
(Instr. 8)
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5. Number of Derivative Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
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6. Date Exercisable and Expiration Date
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7. Title and Amount of Securities Underlying Derivative Security
(Instr. 3 and 4)
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8. Price of Derivative Security
(Instr. 5)
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9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4)
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10. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 4)
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11. Nature of Indirect Beneficial Ownership (Instr. 4)
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Code
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V
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(A)
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(D)
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Date Exercisable
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Expiration Date
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Title
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Amount or Number of Shares
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Employee Stock Options (Right to buy Class A common stock)
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$8.92
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8/8/2019
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A
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199118
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(1)
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8/8/2029
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Class A Common Stock
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199118
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$0.00
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199118
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D
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Class B Common Stock
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(2)
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5/9/2019
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G
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V
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133333
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(2)
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(2)
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Class A Common Stock
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133333
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$0.00
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739781
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D
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Class B Common Stock
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(2)
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5/9/2019
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G
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V
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133333
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(2)
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(2)
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Class A Common Stock
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133333
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$0.00
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606448
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D
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Class B Common Stock
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(2)
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5/9/2019
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G
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V
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133334
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(2)
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(2)
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Class A Common Stock
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133334
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$0.00
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473114
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D
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Class B Common Stock
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(2)
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5/9/2019
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G
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V
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133333
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(2)
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(2)
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Class A Common Stock
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133333
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$0.00
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133333
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I
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By Trust
(3)
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Class B Common Stock
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(2)
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5/9/2019
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G
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V
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133333
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(2)
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(2)
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Class A Common Stock
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133333
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$0.00
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133333
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I
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By Trust
(4)
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Class B Common Stock
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(2)
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5/9/2019
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G
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V
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133334
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(2)
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(2)
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Class A Common Stock
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133334
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$0.00
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133334
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I
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By Trust
(5)
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Explanation of Responses:
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(1)
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The stock options vest as to 25% of the shares on February 15, 2020, with the remainder vesting in equal quarterly installments thereafter over the next three years, subject to the reporting person's continued service with the Company on the vesting date.
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(2)
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All the outstanding shares of our Class B common stock will convert automatically into shares of our Class A common stock upon the occurrence of certain events. In addition, Class B common stock may be converted into shares of Class A common stock at any time at the election of the holder.
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(3)
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Held by the KR Sridhar and Sudha Sarma 2019 Two Year Grantor Retained Annuity Trust
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(4)
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Held by the KR Sridhar and Sudha Sarma 2019 Three Year Grantor Retained Annuity Trust
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(5)
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Held by the KR Sridhar and Sudha Sarma 2019 Four Year Grantor Retained Annuity Trust
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Reporting Owners
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Reporting Owner Name / Address
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Relationships
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Director
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10% Owner
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Officer
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Other
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Sridhar KR
4353 NORTH FIRST STREET
SAN JOSE, CA 95134
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President, CEO
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Signatures
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Shawn Soderberg as attorney-in-fact for reporting person
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8/12/2019
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**
Signature of Reporting Person
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Date
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
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*
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If the form is filed by more than one reporting person,
see
Instruction 4(b)(v).
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**
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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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Note:
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File three copies of this Form, one of which must be manually signed. If space is insufficient,
see
Instruction 6 for procedure.
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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.
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