SEC Form 4 · accession 0000899243-17-010810
Block, Inc. · XYZ
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Roelof Botha
Director
Period of report
Nov 15, 2016
Accepted (ET)
Apr 24, 2017 · 3:18 pm EDT
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0001512673
Table I — non-derivative securities
| Security | Date | Code | Shares | Price | A/D | Owned after | D/I | Nature of ownership |
|---|---|---|---|---|---|---|---|---|
| Class A Common StockF2 | Nov 15, 2016 | J | 40,087 | $0.00 | A | 40,087 | I | By Sequoia Capital U.S. Venture 2010-Seed Fund L.P.(2) |
| Class A Common Stock | holding | — | — | — | 32,782 | D |
Table II — derivative securities
No Table II lines on this filing.
Explanation of responses
- F1These shares were received by Sequoia Capital U.S. Venture 2010-Seed Fund L.P. as part of a pro rata distribution-in-kind to the limited partners of an investment fund. Such shares were included as beneficially owned by the Reporting Person in his Form 4 filed on April 5, 2017.
- F2SC US (TTGP), Ltd. is the general partner of SC U.S. Venture 2010 Management, L.P., which is the general partner of Sequoia Capital U.S. Venture 2010-Seed Fund, L.P. The Reporting Person is a Director of SC US (TTGP), Ltd. The Reporting Person disclaims beneficial ownership of these securities 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.