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*
(Street)
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2. Date of Event Requiring Statement
(Month/Day/Year) 09/27/2010 |
3. Issuer Name and Ticker or Trading Symbol
AMYRIS, INC. [ AMRS ] |
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4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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5. If Amendment, Date of Original Filed
(Month/Day/Year) |
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6. Individual or Joint/Group Filing (Check Applicable Line)
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Table I - Non-Derivative Securities Beneficially Owned | |||
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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) |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||
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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 | ||||
Series D Preferred Stock | (1) | (1) | Common Stock | 7,101,548(1) | (1) | D |
Explanation of Responses: |
1. Upon completion of the Issuer's initial public offering, each outstanding share of Series D Preferred Stock will be automatically converted into shares of Issuer's Common Stock. Due to the antidilution provisions of the Issuer's certificate of incorporation that apply to the Series D Preferred Stock, an additional 2,549,456 shares of Common Stock will be issued to Total Gas & Power USA, SAS upon the closing on or before September 30, 2010 of the Issuer's initial public offering assuming a per share offering price of $16.00, or an additional 3,714,109 shares of Common Stock will be issued to Total Gas & Power USA, SAS upon closing after September 30, 2010 assuming a per share offering price of $16.00. Total Gas & Power USA, SAS holds 7,101,548 shares of Series D Preferred Stock before giving effect to the automatic conversion. The Series D Preferred Stock has no expiration date. |
Remarks: |
Exhibit List ---------------- Exhibit 24 - Power of Attorney |
/s/ Arnaud Chaperon, Chairman, Total Gas & Power SAS by Tamara Tompkins, Attorney-in-Fact | 09/27/2010 | |
** 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). | ||
** 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 Number. |