Please wait

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

OMB APPROVAL OMB Number: 3235-0104 Estimated average burden hours per response: 0.5

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) Relationship of Reporting Person(s) to Issuer Director X 10% Owner Officer (give title below) Other (specify below)

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) Relationship of Reporting Person(s) to Issuer Director X 10% Owner Officer (give title below) Other (specify below)

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) Relationship of Reporting Person(s) to Issuer Director X 10% Owner Officer (give title below) Other (specify below)

1. Name and Address of Reporting Person* Hager Barbara (Last) (First) (Middle) 751 LAUREL STREET #717 (Street) SAN CARLOS CA 94070 (City) (State) (Zip) Relationship of Reporting Person(s) to Issuer Director X 10% Owner Officer (give title below) Other (specify below)

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).
** 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.