SEC FORM 3 SEC Form 3
FORM 3 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES

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*
Doerr Ann Howland

(Last) (First) (Middle)
751 LAUREL STREET, #717

(Street)
SAN CARLOS CA 94070

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
08/17/2018
3. Issuer Name and Ticker or Trading Symbol
AMYRIS, INC. [ AMRS ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director X 10% Owner
Officer (give title below) Other (specify below)
5. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
Form filed by One Reporting Person
X Form filed by More than One Reporting Person
Table I - Non-Derivative Securities Beneficially Owned
1. Title of Security (Instr. 4) 2. Amount of Securities Beneficially Owned (Instr. 4) 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 4. Nature of Indirect Beneficial Ownership (Instr. 5)
Common Stock 7,852,775(1) I By Foris Ventures, LLC(2)
Common Stock 567 I By The Vallejo Ventures Trust U/T/A 2/12/96(3)
Common Stock 5,532 I By L. John Doerr(4)
Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 4) 2. Date Exercisable and Expiration Date (Month/Day/Year) 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) 4. Conversion or Exercise Price of Derivative Security 5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 6. Nature of Indirect Beneficial Ownership (Instr. 5)
Date Exercisable Expiration Date Title Amount or Number of Shares
6.50% Convertible Senior Notes due 2019 (5) 05/15/2019 Common Stock 89,037 (5) I By Foris Ventures, LLC(2)
Warrant (Right to Buy) (6) (6) Common Stock 64,103 0.15 I By Foris Ventures, LLC(2)
Warrant (Right to Buy) (7) (7) Common Stock 152,381 0.15 I By Foris Ventures, LLC(2)
Warrant (Right to Buy) (8) (8) Common Stock 4,877,386 7.52 I By Foris Ventures, LLC(2)
Stock Option (Right to Buy) 08/01/2019 08/01/2028 Common Stock 3,466 6.96 I By L. John Doerr(4)
Stock Option (Right to Buy) 08/02/2018 08/02/2027 Common Stock 1,733 3.93 I By L. John Doerr(4)
Stock Option (Right to Buy) 07/13/2017 07/13/2026 Common Stock 1,733 6.08 I By L. John Doerr(4)
Stock Option (Right to Buy) 08/11/2016 07/13/2026 Common Stock 400 25.35 I By L. John Doerr(4)
Stock Option (Right to Buy) 08/07/2015 08/06/2024 Common Stock 400 57.9 I By L. John Doerr(4)
Stock Option (Right to Buy) 08/08/2014 08/01/2023 Common Stock 400 41.4 I By L. John Doerr(4)
Stock Option (Right to Buy) 08/09/2013 07/19/2022 Common Stock 400 53.25 I By L. John Doerr(4)
Stock Option (Right to Buy) 08/07/2012 07/19/2021 Common Stock 400 367.5 I By L. John Doerr(4)
Stock Option (Right to Buy) 06/15/2011 03/15/2021 Common Stock 1,333 452.55 I By L. John Doerr(4)
1. Name and Address of Reporting Person*
Doerr Ann Howland

(Last) (First) (Middle)
751 LAUREL STREET, #717

(Street)
SAN CARLOS CA 94070

(City) (State) (Zip)
1. Name and Address of Reporting Person*
Foris Ventures, LLC

(Last) (First) (Middle)
751 LAUREL STREET #717

(Street)
SAN CARLOS CA 94070

(City) (State) (Zip)
1. Name and Address of Reporting Person*
Vallejo Ventures Trust UTA 21296

(Last) (First) (Middle)
751 LAUREL STREET #717

(Street)
SAN CARLOS CA 94070

(City) (State) (Zip)
1. Name and Address of Reporting Person*
Hager Barbara

(Last) (First) (Middle)
751 LAUREL STREET #717

(Street)
SAN CARLOS CA 94070

(City) (State) (Zip)
Explanation of Responses:
1. Includes 1,012,071 shares of Common Stock issuable to Foris Ventures, LLC ("Foris") following the October 9, 2017 automatic conversion of the Company's Series B 17.38% Convertible Preferred Stock ("Series B Preferred Stock") into Common Stock. Pursuant to the Series B Certificate of Designation, the automatic conversion of the Series B Preferred Stock held by Foris to Common Stock will be held in abeyance to the extent such conversion would cause Foris to beneficially own in excess of 9.99% of the number of shares of Common Stock outstanding (the "Beneficial Ownership Limitation"), until Foris is able to receive such shares without exceeding the Beneficial Ownership Limitation, but all rights under the Series B Certificate of Designation shall cease to apply, other than the right to convert.
2. The Vallejo Ventures Trust U/T/A 2/12/96 ("VVT") is the member of Foris. L. John Doerr and Ann Doerr are the trustees of VVT. Barbara Hager is the special trustee of VVT and manager of Foris. By virtue of these relationships, each of VVT, Ann Doerr and Barbara Hager may be deemed to have the power to vote and dispose of shares held by Foris. Each of VVT, Ann Doerr and Barbara Hager disclaims beneficial ownership of the shares held by Foris except to the extent of her or its pecuniary interest therein, if any.
3. L. John Doerr and Ann Doerr are the trustees of VVT. Barbara Hager is the special trustee of VVT and manager of Foris. By virtue of these relationships, Ann Doerr and Barbara Hager may be deemed to have the power to vote and dispose of shares held by VVT. Each of Ann Doerr and Barbara Hager disclaims beneficial ownership of the shares held by VVT except to the extent of her pecuniary interest therein, if any.
4. L. John Doerr is the husband of Ann Doerr.
5. The 6.50% Convertible Senior Note due 2019 held by Foris (the "Foris 6.50% Note due 2019") is convertible into shares of the Company's Common Stock at a conversion rate of 17.8073 shares per $1,000 in principal (which conversion rate is subject to adjustment in certain circumstances), representing an effective conversion price of approximately $56.16 per share. The principal amount of the Foris 6.50% Note due 2019 is $5,000,000.
6. The exercisability of the warrant was subject to the approval of the stockholders of the Issuer, which was obtained on September 17, 2015. The warrant expires on July 29, 2020.
7. The exercisability of the warrant was subject to the approval of the stockholders of the Issuer, which was obtained on May 17, 2016. The warrant expires on February 12, 2021.
8. The warrant is exercisable beginning on February 17, 2019 (the "Initial Exercise Date"), the six month anniversary of the issuance of the warrant. The warrant expires on the fifteen month anniversary of the Initial Exercise Date.
Remarks:
FORIS VENTURES, LLC, By: /s/ Barbara Hager , Printed Name: Barbara Hager, Title: Manager 08/27/2018
The Vallejo Ventures Trust U/T/A 2/12/96, By: /s/ Barbara Hager , Printed Name: Barbara Hager, Title: Special Trustee 08/27/2018
/s/ Ann Howland Doerr 08/27/2018
/s/ Barbara Hager 08/27/2018
** 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 5 (b)(v).
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