SEC Form 4 · accession 0001209191-17-040416
Block, Inc. · XYZ
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Roelof Botha
Director
Period of report
Jun 14, 2017
Accepted (ET)
Jun 16, 2017 · 3:51 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 StockF1 | Jun 14, 2017 | A | 10,651 | $0.00 | A | 43,433 | D | |
| Class A Common StockF2 | 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
- F1Represents an automatic annual restricted stock unit (RSU) award issued pursuant to the Issuer's Outside Director Compensation Policy. Each RSU represents a contingent right to receive one share of Issuer's Class A Common Stock upon settlement. 100% of the RSUs vest on the earlier of June 14, 2017, or the Issuer's next annual meeting of stockholders.
- 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.