SEC Form 4 · accession 0001209191-19-002310
Block, Inc. · XYZ
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Roelof Botha
Director
Period of report
Jan 2, 2019
Accepted (ET)
Jan 4, 2019 · 7:04 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 StockF1 | Jan 2, 2019 | A | 245 | $0.00 | A | 49,567 | D | |
| Class A Common StockF2 | holding | — | — | — | 719,981 | I | Sequoia Capital U.S. Venture 2010-Seed Fund, L.P. | |
| Class A Common StockF3 | holding | — | — | — | 858,081 | I | Sequoia Capital U.S. Growth Fund IV, L.P. | |
| Class A Common StockF3 | holding | — | — | — | 35,657 | I | Sequoia Capital USGF Principals Fund IV, L.P. | |
| Class A Common Stock | holding | — | — | — | 127,321 | I | By estate planning vehicle |
Table II — derivative securities
No Table II lines on this filing.
Explanation of responses
- F1Each share is represented by a restricted stock unit (RSU). Each RSU represents a contingent right to receive one share of the Issuer's Class A Common Stock upon settlement. The RSUs were issued pursuant to the Issuer's Outside Director Compensation Policy, and 100% of the RSUs were vested as of the date of grant.
- 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., 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.
- 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 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.