0000899243-17-016097.txt : 20170612
0000899243-17-016097.hdr.sgml : 20170612
20170612165137
ACCESSION NUMBER: 0000899243-17-016097
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20170608
FILED AS OF DATE: 20170612
DATE AS OF CHANGE: 20170612
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: Square, Inc.
CENTRAL INDEX KEY: 0001512673
STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-PREPACKAGED SOFTWARE [7372]
IRS NUMBER: 800429876
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 1455 MARKET STREET
STREET 2: SUITE 600
CITY: SAN FRANCISCO
STATE: CA
ZIP: 94103
BUSINESS PHONE: 415-375-3176
MAIL ADDRESS:
STREET 1: 1455 MARKET STREET
STREET 2: SUITE 600
CITY: SAN FRANCISCO
STATE: CA
ZIP: 94103
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: KHOSLA VINOD
CENTRAL INDEX KEY: 0001032453
STATE OF INCORPORATION: CA
FISCAL YEAR END: 1231
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-37622
FILM NUMBER: 17907076
MAIL ADDRESS:
STREET 1: 2128 SAND HILL RD
CITY: MENLO PARK
STATE: CA
ZIP: 94025
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: VK Services, LLC
CENTRAL INDEX KEY: 0001501927
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-37622
FILM NUMBER: 17907077
BUSINESS ADDRESS:
STREET 1: 3000 SAND HILL ROAD
STREET 2: BUILDING 3, SUITE 190
CITY: MENLO PARK
STATE: CA
ZIP: 94025
BUSINESS PHONE: (650) 376-8510
MAIL ADDRESS:
STREET 1: 3000 SAND HILL ROAD
STREET 2: BUILDING 3, SUITE 190
CITY: MENLO PARK
STATE: CA
ZIP: 94025
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Khosla Ventures Associates III, LLC
CENTRAL INDEX KEY: 0001501934
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-37622
FILM NUMBER: 17907078
BUSINESS ADDRESS:
STREET 1: 3000 SAND HILL ROAD
STREET 2: BUILDING 3, SUITE 190
CITY: MENLO PARK
STATE: CA
ZIP: 94025
BUSINESS PHONE: (650) 376-8510
MAIL ADDRESS:
STREET 1: 3000 SAND HILL ROAD
STREET 2: BUILDING 3, SUITE 190
CITY: MENLO PARK
STATE: CA
ZIP: 94025
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Khosla Ventures III, L.P.
CENTRAL INDEX KEY: 0001471809
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-37622
FILM NUMBER: 17907079
BUSINESS ADDRESS:
STREET 1: 3000 SAND HILL ROAD
STREET 2: BUILDING 3, SUITE 170
CITY: MENLO PARK
STATE: CA
ZIP: 94025
BUSINESS PHONE: (650) 376-8510
MAIL ADDRESS:
STREET 1: 3000 SAND HILL ROAD
STREET 2: BUILDING 3, SUITE 170
CITY: MENLO PARK
STATE: CA
ZIP: 94025
4
1
doc4.xml
FORM 4 SUBMISSION
X0306
4
2017-06-08
1
0001512673
Square, Inc.
SQ
0001471809
Khosla Ventures III, L.P.
2128 SAND HILL ROAD
MENLO PARK
CA
94025
0
0
0
1
former 10% holder
0001501934
Khosla Ventures Associates III, LLC
2128 SAND HILL ROAD
MENLO PARK
CA
94025
0
0
0
1
former 10% holder
0001501927
VK Services, LLC
2128 SAND HILL ROAD
MENLO PARK
CA
94025
0
0
0
1
former 10% holder
0001032453
KHOSLA VINOD
2128 SAND HILL ROAD
MENLO PARK
CA
94025
0
0
0
1
former 10% holder
Class A Common Stock
2017-06-08
4
J
0
5000000
0.00
D
0
I
See footnote
Class A Common Stock
2017-06-08
4
J
0
454545
0.00
A
454545
I
See footnote
Class A Common Stock
2017-06-08
4
J
0
454545
0.00
D
0
I
See footnote
Class A Common Stock
2017-06-08
4
J
0
439545
0.00
A
2549361
I
See footnote
Consists of securities held of record by Khosla Ventures III, LP ("KV III"), of which Khosla Ventures Associates III, LLC ("KVA III") is the general partner. Vinod Khosla is the managing member of VK Services, LLC ("VK Services"), which is the manager of KVA III. Each of KVA III, VK Services and Vinod Khosla may be deemed to possess voting and investment control over such securities, and each of KVA III, VK Services and Vinod Khosla may be deemed to have indirect beneficial ownership of such securities. Each Reporting Person disclaims beneficial ownership of such shares except to the extent of his or its pecuniary interest therein.
On June 8, 2017, 5,000,000 shares of Class A Common Stock held by KV III were distributed to the limited partners and general partners of KV III.
On June 8, 2017, 454,545 shares of Class A Common Stock held by KVA III were distributed to the members of KVA III.
Consists of securities held of record by KVA III. Vinod Khosla is the managing member of VK Services, which is the manager of KVA III. Each of KVA III, VK Services and Vinod Khosla may be deemed to possess voting and investment control over such securities, and each of KVA III, VK Services and Vinod Khosla may be deemed to have indirect beneficial ownership of such securities. Each Reporting Person disclaims beneficial ownership of such shares except to the extent of his or its pecuniary interest therein.
Consists of securities held of record by VK Services. Vinod Khosla is the managing member of VK Services. Each of VK Services and Vinod Khosla may be deemed to possess voting and investment control over such securities, and each of VK Services and Vinod Khosla may be deemed to have indirect beneficial ownership of such securities. Each Reporting Person disclaims beneficial ownership of such shares except to the extent of his or its pecuniary interest therein.
/s/ John J. Demeter, as attorney in fact for Vinod Khosla, as Managing Member of VK Services, LLC, in its capacity as Manager of Khosla Ventures Associates III, LLC, in its capacity as general partner of Khosla Ventures III, L.P.
2017-06-12
/s/ John J. Demeter, as attorney in fact for Vinod Khosla, as Managing Member of VK Services, LLC, in its capacity as Manager of Khosla Ventures Associates III, LLC
2017-06-12
/s/ John J. Demeter, as attorney in fact for Vinod Khosla, as Managing Member of VK Services, LLC
2017-06-12
/s/ John J. Demeter, as attorney in fact for Vinod Khosla
2017-06-12