0001209191-15-082259.txt : 20151125 0001209191-15-082259.hdr.sgml : 20151125 20151125162748 ACCESSION NUMBER: 0001209191-15-082259 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 2 CONFORMED PERIOD OF REPORT: 20151124 FILED AS OF DATE: 20151125 DATE AS OF CHANGE: 20151125 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: 901 MISSION STREET STREET 2: SUITE 104 CITY: SAN FRANCISCO STATE: CA ZIP: 94103 BUSINESS PHONE: 415-375-3176 MAIL ADDRESS: STREET 1: 901 MISSION STREET STREET 2: SUITE 104 CITY: SAN FRANCISCO STATE: CA ZIP: 94103 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: ACCESS INDUSTRIES MANAGEMENT, LLC CENTRAL INDEX KEY: 0001508226 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-37622 FILM NUMBER: 151256481 BUSINESS ADDRESS: STREET 1: 730 FIFTH AVENUE CITY: NEW YORK STATE: NY ZIP: 10019 BUSINESS PHONE: 2122476400 MAIL ADDRESS: STREET 1: 730 FIFTH AVENUE CITY: NEW YORK STATE: NY ZIP: 10019 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: AI Palma Holdings LLC CENTRAL INDEX KEY: 0001659086 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-37622 FILM NUMBER: 151256482 BUSINESS ADDRESS: STREET 1: 730 FIFTH AVENUE STREET 2: 20TH FL CITY: NEW YORK STATE: NY ZIP: 10019 BUSINESS PHONE: 212-247-6400 MAIL ADDRESS: STREET 1: 730 FIFTH AVENUE STREET 2: 20TH FL CITY: NEW YORK STATE: NY ZIP: 10019 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Blavatnik Len CENTRAL INDEX KEY: 0001326628 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-37622 FILM NUMBER: 151256483 MAIL ADDRESS: STREET 1: C/O ACCESS INDUSTRIES STREET 2: 730 FIFTH AVENUE CITY: NEW YORK STATE: NY ZIP: 10019 3 1 doc3.xml FORM 3 SUBMISSION X0206 3 2015-11-24 0 0001512673 Square, Inc. SQ 0001659086 AI Palma Holdings LLC 730 FIFTH AVE, 20TH FL NEW YORK NY 10019 0 0 1 0 0001508226 ACCESS INDUSTRIES MANAGEMENT, LLC 730 FIFTH AVE, 20TH FL NEW YORK NY 10019 0 0 1 0 0001326628 Blavatnik Len 730 FIFTH AVE, 20TH FL NEW YORK NY 10019 0 0 1 0 Class B Common Stock Common Stock 3999998 D The Class B Common Stock is convertible into Class A Common Stock on a 1:1 basis and has no expiration date. The securities reported are held directly by AI Palma Holdings LLC ("Palma") and may be deemed to be indirectly beneficially owned by Access Industries Management, LLC and Len Blavatnik because Access Industries Management, LLC is the manager of Palma, and Mr. Blavatnik controls Access Industries Management, LLC and Palma. Each of the reporting persons (other than Palma) disclaims beneficial ownership of the securities held directly by Palma except to the extent of any pecuniary interest therein, and this Form shall not be construed as an admission that any such reporting person is the beneficial owner of any such securities. The reporting persons may be deemed to beneficially own more than 10% of the Issuer's Class A Common Stock, which is the class of equity securities registered under Section 12 of the Securities Exchange Act of 1934, as amended (the "Exchange Act"), by virtue of the treatment of the securities held by the reporting persons only as being converted into Class A Common Stock for the purpose of computing the reporting persons' percentage ownership of Class A Common Stock. The filing of this Form 3 shall not be deemed an admission that the reporting persons are required to file reports pursuant to Section 16 of the Exchange Act. /s/ Alejandro Moreno for AI Palma Holdings LLC 2015-11-25 /s/ Alejandro Moreno for Access Industries Management, LLC 2015-11-25 /s/ Alejandro Moreno, as Attorney-in-Fact for Mr. Blavatnik 2015-11-25 EX-24.1 2 attachment1.htm EX-24.1 DOCUMENT

POWER OF ATTORNEY


Know all by these presents, that the undersigned hereby constitutes and appoints
Lincoln Benet, Alejandro Moreno and Richard Storey, and each of them
individually, the undersigned's true and lawful attorney-in-fact to:
(1) 	execute for and on behalf of the undersigned, in the undersigned's capacity
as a beneficial owner of Square, Inc. (the "Company"), (i) Forms 3, 4 and 5 and
any other forms required to be filed in accordance with Section 16(a) of the
Securities Exchange Act of 1934 (the "Exchange Act") and the rules thereunder (a
"Section 16 Form"), (ii) all forms and schedules in accordance with Section
13(d) of the Exchange Act and the rules thereunder, including all amendments
thereto (a "Section 13 Schedule"), (iii) a Form ID Application, Passphrase
Update Application and/or request to convert from paper only to electronic filer
with the US Securities and Exchange Commission and to obtain access codes to
file on EDGAR and any other forms required to be filed or submitted in
accordance with Regulation S-T promulgated by the United States Securities and
Exchange Commission (or any successor provision) in order to file a Section 13
Schedule or a Section 16 Form electronically (a "Form ID", and, together with a
Section 13 Schedule and Section 16 Form, the "Forms and Schedules") and (iv) any
Joint Filing Agreement or similar agreement with respect to the filing of any of
the Forms or Schedules in (i) through (iii) above;
(2) 	do and perform any and all acts for and on behalf of the undersigned which
may be necessary or desirable to complete and execute any such Forms and
Schedules, complete and execute any amendment or amendments thereto, and timely
file such Forms and Schedules with the United States Securities and Exchange
Commission and any stock exchange or similar authority; and
(3) 	take any other action of any type whatsoever in connection with the
foregoing which, in the opinion of each such attorney-in-fact, may be of benefit
to, in the best interest of, or legally required by, the undersigned, it being
understood that the documents executed by each such attorney-in-fact on behalf
of the undersigned pursuant to this Power of Attorney shall be in such form and
shall contain such terms and conditions as he may approve in his discretion.
The undersigned hereby grants to each such attorney-in-fact full power and
authority to do and perform any and every act and thing whatsoever requisite,
necessary or proper to be done in the exercise of any of the rights and powers
herein granted, as fully to all intents and purposes as the undersigned might or
could do if personally present, with full power of substitution or revocation,
hereby ratifying and confirming all that each such attorney-in-fact, or his
substitute or substitutes, shall lawfully do or cause to be done by virtue of
this Power of Attorney and the rights and powers herein granted.  The
undersigned acknowledges that each such attorney-in-fact is serving in such
capacity at the request of the undersigned, and is not assuming, nor is the
Company assuming, any of the undersigned's responsibilities to comply with
Section 13 or Section 16 of the Exchange Act.
The Power of Attorney shall remain in full force and effect until the
undersigned is no longer required to file any Forms and Schedules with respect
to the undersigned's holdings of and transactions in securities issued by the
Company, unless earlier revoked by the undersigned in a signed writing delivered
to each such attorney-in-fact.
From and after the date hereof, any Power of Attorney previously granted by the
undersigned concerning the subject matter hereof is hereby revoked.
IN WITNESS WHEREOF, the undersigned has executed this Power of Attorney on this
24th day of November, 2015.
LEONARD BLAVATNIK


/s/ Leonard Blavatnik