0001209191-22-001786.txt : 20220105
0001209191-22-001786.hdr.sgml : 20220105
20220105170433
ACCESSION NUMBER: 0001209191-22-001786
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20220103
FILED AS OF DATE: 20220105
DATE AS OF CHANGE: 20220105
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: BOTHA ROELOF
CENTRAL INDEX KEY: 0001222287
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-37622
FILM NUMBER: 22512144
MAIL ADDRESS:
STREET 1: C/O SEQUOIA CAPITAL
STREET 2: 2800 SAND HILL RD, SUITE 101
CITY: MENLO PARK
STATE: CA
ZIP: 94025
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: Block, 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
FORMER COMPANY:
FORMER CONFORMED NAME: Square, Inc.
DATE OF NAME CHANGE: 20110210
4
1
doc4.xml
FORM 4 SUBMISSION
X0306
4
2022-01-03
0
0001512673
Block, Inc.
SQ
0001222287
BOTHA ROELOF
C/O SEQUOIA CAPITAL, 2800 SAND HILL ROAD
SUITE 101
MENLO PARK
CA
94025
1
0
0
0
Class A Common Stock
2022-01-03
4
A
0
85
0.00
A
12348
D
Class A Common Stock
1862
I
Sequoia Capital U.S. Growth Fund IV, L.P.
Class A Common Stock
77
I
Sequoia Capital USGF Principals Fund IV, L.P.
Class A Common Stock
684741
I
By estate planning vehicle
Class A Common Stock
11388
I
Sequoia Capital U.S. Venture Fund XV, L.P.
Class A Common Stock
479
I
Sequoia Capital U.S. Venture Partners Fund XV (Q), L.P.
Class A Common Stock
171
I
Sequoia Capital U.S. Venture Partners Fund XV, L.P.
Class A Common Stock
1750
I
Sequoia Capital U.S. Venture XV Principals Fund, L.P.
Each share is represented by a restricted stock unit (RSU). Each RSU represents a contingent right to receive one share of the Issuer's Class A Common Stock upon settlement. The RSUs were issued pursuant to the Issuer's Outside Director Compensation Policy, and 100% of the RSUs were vested as of the date of grant.
SC US (TTGP), Ltd. is the general partner of SCGF IV Management, L.P., which is the general partner of Sequoia Capital U.S. Growth Fund IV, L.P. and Sequoia Capital USGF Principals Fund IV, L.P., or collectively, the SC GFIV Funds. The Reporting Person is a Director of SC US (TTGP), Ltd. The Reporting Person disclaims beneficial ownership of the securities held by the SC GFIV Funds except to the extent of his pecuniary interest therein, and the inclusion of these securities in this report shall not be deemed an admission of beneficial ownership of the reported securities for purposes of Section 16 or for any other purposes.
SC US (TTGP), Ltd. is the general partner of SC U.S. Venture XV Management, L.P., which is the general partner of Sequoia Capital U.S. Venture Fund XV, L.P., Sequoia Capital U.S. Venture Partners Fund XV (Q), L.P., Sequoia Capital U.S. Venture Partners Fund XV, L.P. and Sequoia Capital U.S. Venture XV Principals Fund, L.P., or collectively, the SC USV XV Funds. The Reporting Person is a Director of SC US (TTGP), Ltd. The Reporting Person disclaims beneficial ownership of the securities held by the SC USV XV Funds except to the extent of his pecuniary interest therein, and the inclusion of these securities in this report shall not be deemed an admission of beneficial ownership of the reported securities for purposes of Section 16 or for any other purposes.
/s/ Susan Szotek, Attorney-in-Fact
2022-01-05