SEC Form 4 · accession 0001144204-18-063183

Block, Inc. · XYZ

Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗

Reporting owner

Mary G Meeker

Director

Period of report

Nov 30, 2018

Accepted (ET)

Dec 4, 2018 · 8:10 pm EST

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 Stock^F3	Nov 30, 2018	J	25,187	$0.00	D	62,386	I	See Footnote
Class A Common Stock^F5	Nov 30, 2018	J	18,800	$0.00	A	309,876	D
Class A Common Stock^F6,F3	Dec 3, 2018	S	11,719	$71.43	D	50,667	I	See Footnote
Class A Common Stock^F1	holding	—	—		—	1,253,693	I	See Footnote
Class A Common Stock^F7	holding	—	—		—	10,072	I	See Footnote

Table II — derivative securities

No Table II lines on this filing.

Explanation of responses

F1KPCB Holdings, Inc., as nominee, holds the stock for the account of KPCB Digital Growth Fund, LLC (?KPCB Growth?), KPCB DGF Founders Fund, LLC (?KPCB FF?), and KPCB sFund, LLC (?KPCB sFund?). All shares are held for convenience in the name of ?KPCB Holdings, Inc., as nominee? for the accounts of such entities who each exercise their own voting and dispositive power of such shares. The reporting person is a managing member of KPCB DGF Associates, LLC (?DGF Associates?), which is the managing member of KPCB Growth and KPCB FF. The reporting person may be deemed to share voting and investment power over the securities held by KPCB Growth, KPCB FF and sFund. The reporting person disclaims beneficial ownership over such securities except to the extent of her 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 a pro-rata in-kind distribution of Class A Common Stock of the Issuer by DGF Associates without consideration to its members (the ?DGF Associates Distribution?).
F3The shares are held directly by DGF Associates. The reporting person is a managing member of DGF Associates and may be deemed to share voting and investment power over the securities held by DGF Associates. The reporting person disclaims beneficial ownership over such securities except to the extent of her 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.
F4Represents a change in the form of ownership from indirect to direct by virtue of the receipt of shares in the DGF Associates Distribution.
F5Shares are held directly by the reporting person.
F6The price reported in column 4 is a weighted average price. These shares were sold in multiple transactions at prices ranging from $71.42 to $71.44, inclusive. The reporting person undertakes to provide to the issuer, any security holder of the issuer, or the staff of the Securities and Exchange Commission, upon request, full information regarding the number of shares sold at each separate price within the ranges set forth in footnote (6) to this Form 4.
F7The shares are held directly by KPCB sFund Associates, LLC (?sFund Associates?). The reporting person is a member of sFund Associates and may be deemed to share voting and investment power over the securities held by sFund Associates. The reporting person disclaims beneficial ownership over such securities except to the extent of her 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.