SEC Form 4
FORM 4 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP

Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934
or Section 30(h) of the Investment Company Act of 1940
OMB APPROVAL
OMB Number: 3235-0287
Estimated average burden
hours per response: 0.5
  
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
1. Name and Address of Reporting Person*
BOTHA ROELOF

(Last) (First) (Middle)
C/O SEQUOIA CAPITAL,
2800 SAND HILL ROAD SUITE 101

(Street)
MENLO PARK CA 94025

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
Square, Inc. [ SQ ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director 10% Owner
Officer (give title below) Other (specify below)
3. Date of Earliest Transaction (Month/Day/Year)
12/03/2018
4. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
X Form filed by One Reporting Person
Form filed by More than One Reporting Person
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
1. Title of Security (Instr. 3) 2. Transaction Date (Month/Day/Year) 2A. Deemed Execution Date, if any (Month/Day/Year) 3. Transaction Code (Instr. 8) 4. Securities Acquired (A) or Disposed Of (D) (Instr. 3, 4 and 5) 5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4) 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 7. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V Amount (A) or (D) Price
Class A Common Stock 12/03/2018 C 2,779,822 A $0.00 2,779,822 I By Sequoia Capital U.S. Venture 2010 Fund, LP(1)
Class A Common Stock 12/03/2018 C 304,186 A $0.00 304,186 I By Sequoia Capital U.S. Venture 2010 Partners Fund (Q), LP(1)
Class A Common Stock 12/03/2018 C 61,654 A $0.00 61,654 I By Sequoia Capital U.S. Venture 2010 Partners Fund, LP(1)
Class A Common Stock 12/03/2018 J(2) 2,779,822 D $0.00 0 I By Sequoia Capital U.S. Venture 2010 Fund, LP(1)
Class A Common Stock 12/03/2018 J(2) 304,186 D $0.00 0 I By Sequoia Capital U.S. Venture 2010 Partners Fund (Q), LP(1)
Class A Common Stock 12/03/2018 J(2) 61,654 D $0.00 0 I By Sequoia Capital U.S. Venture 2010 Partners Fund, LP(1)
Class A Common Stock 12/03/2018 J(2) 179,995 D $0.00 719,981 I By Sequoia Capital U.S. Venture 2010-Seed Fund, L.P.(1)
Class A Common Stock 12/03/2018 J(3) 127,231 A $0.00 127,231 I By estate planning vehicle
Class A Common Stock 49,322 D
Class A Common Stock 858,081 I By Sequoia Capital U.S. Growth Fund IV, L.P.(4)
Class A Common Stock 35,657 I By Sequoia Capital USGF Principals Fund IV, L.P.(4)
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 3) 2. Conversion or Exercise Price of Derivative Security 3. Transaction Date (Month/Day/Year) 3A. Deemed Execution Date, if any (Month/Day/Year) 4. Transaction Code (Instr. 8) 5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) 6. Date Exercisable and Expiration Date (Month/Day/Year) 7. Title and Amount of Securities Underlying Derivative Security (Instr. 3 and 4) 8. Price of Derivative Security (Instr. 5) 9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) 10. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 11. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V (A) (D) Date Exercisable Expiration Date Title Amount or Number of Shares
Class B Common Stock (5) 12/03/2018 C 2,779,822 (5) (5) Class A Common Stock 2,779,822 $0.00 11,119,288 I By Sequoia Capital U.S. Venture 2010 Fund, LP(1)
Class B Common Stock (5) 12/03/2018 C 304,186 (5) (5) Class A Common Stock 304,186 $0.00 1,216,744 I By Sequoia Capital U.S. Venture 2010 Partners Fund (Q), LP(1)
Class B Common Stock (5) 12/03/2018 C 61,654 (5) (5) Class A Common Stock 61,654 $0.00 246,616 I By Sequoia Capital U.S. Venture 2010 Partners Fund, LP(1)
Explanation of Responses:
1. SC US (TTGP), Ltd. is the sole general partner of SC U.S. Venture 2010 Management, L.P., which is the sole general partner of each of Sequoia Capital U.S. Venture 2010 Fund, LP, Sequoia Capital U.S. Venture 2010 Partners Fund, LP, Sequoia Capital U.S. Venture 2010 Partners Fund (Q), LP and 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.
2. Represents a distribution of Class A Common Stock of the Issuer to partners or members and includes subsequent distributions by general partners or managing members to their respective partners or members.
3. Represents the receipt of shares of Class A Common Stock of the Issuer by virtue of the pro rata in-kind distributions described in footnote (2) above.
4. SC 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.
5. Each share of Class B Common Stock is convertible into one share of Class A Common Stock at the option of the holder and has no expiration date.
Remarks:
/s/ Jung Yeon Son, Attorney-In-Fact 12/06/2018
** Signature of Reporting Person Date
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
* If the form is filed by more than one reporting person, see Instruction 4 (b)(v).
** Intentional misstatements or omissions of facts constitute Federal Criminal Violations See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure.
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number.