SEC Form 4 · accession 0000899243-18-015035
Block, Inc. · XYZ
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Roelof Botha
Director
Period of report
May 31, 2018
Accepted (ET)
Jun 4, 2018 · 8:33 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,F3 | May 31, 2018 | A | 854,606 | — | A | 854,606 | I | Sequoia Capital U.S. Growth Fund IV, LP |
| Class A Common StockF2,F3 | May 31, 2018 | A | 35,515 | — | A | 35,515 | I | Sequoia Capital USGF Principals Fund IV, L.P. |
| Class A Common Stock | holding | — | — | — | 45,171 | D | ||
| Class A Common StockF1 | holding | — | — | — | 899,976 | I | Sequoia Capital U.S. Venture 2010-Seed Fund, L.P. |
Table II — derivative securities
No Table II lines on this filing.
Explanation of responses
- F1SC 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., or collectively, the Venture 2010 Funds. The Reporting Person is a Director of SC US (TTGP), Ltd. The Reporting Person disclaims beneficial ownership of the securities held by the Venture 2010 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.
- F2Represents shares of Class A Common Stock of the Issuer received on May 31, 2018 as transaction consideration pursuant to the Agreement and Plan of Reorganization, dated April 26, 2018, between the Issuer, Weebly, Inc. and the other parties thereto.
- F3SC 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 its 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.