0000899243-21-041770.txt : 20211027 0000899243-21-041770.hdr.sgml : 20211027 20211027195013 ACCESSION NUMBER: 0000899243-21-041770 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20211025 FILED AS OF DATE: 20211027 DATE AS OF CHANGE: 20211027 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Tepper Jeffrey CENTRAL INDEX KEY: 0001665610 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-40284 FILM NUMBER: 211354599 MAIL ADDRESS: STREET 1: 1001 SEVENTEENTH STREET, SUITE 1800 STREET 2: C/O RIVERSTONE EQUITY CITY: DENVER STATE: CO ZIP: 80202 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Decarbonization Plus Acquisition Corp III CENTRAL INDEX KEY: 0001844862 STANDARD INDUSTRIAL CLASSIFICATION: MISCELLANEOUS ELECTRICAL MACHINERY, EQUIPMENT & SUPPLIES [3690] IRS NUMBER: 861888095 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 2744 SAND HILL ROAD CITY: MENLO PARK STATE: CA ZIP: 94025 BUSINESS PHONE: (212) 993-0076 MAIL ADDRESS: STREET 1: 2744 SAND HILL ROAD CITY: MENLO PARK STATE: CA ZIP: 94025 4 1 doc4.xml FORM 4 SUBMISSION X0306 4 2021-10-25 0 0001844862 Decarbonization Plus Acquisition Corp III DCRC 0001665610 Tepper Jeffrey C/O DECARBONIZATION PLUS ACQ CORP III 2744 SAND HILL ROAD, SUITE 100 MENLO PARK CA 94025 1 0 0 0 Class A Common Stock 2021-10-25 4 C 0 40000 A 40000 D Class B Common Stock 2021-10-25 4 C 0 40000 D Class A Common Stock 40000 0 D In accordance with the amended and restated certificate of incorporation of Decarbonization Plus Acquisition Corporation III ("DCRC"), the Reporting Person elected to convert his shares of Class B Common Stock into shares of Class A Common Stock on a one-for-one basis. The shares of Class B Common Stock were (i) convertible into shares of Class A Common Stock at the Reporting Person's election on a one-for-one basis and (ii) automatically convertible into shares of Class A Common Stock at the time of DCRC's initial business combination on a one-for-one basis, subject to adjustment pursuant to certain anti-dilution rights (which rights were waived by the Reporting Person in connection with DCRC's proposed business combination), and had no expiration date. Jeffrey Tepper, /s/ Peter Haskopoulos, Attorney-in-fact 2021-10-27