0000899243-15-008836.txt : 20151124
0000899243-15-008836.hdr.sgml : 20151124
20151124171431
ACCESSION NUMBER: 0000899243-15-008836
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20151124
FILED AS OF DATE: 20151124
DATE AS OF CHANGE: 20151124
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: Square, Inc.
CENTRAL INDEX KEY: 0001512673
STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-PREPACKAGED SOFTWARE [7372]
IRS NUMBER: 800429876
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 901 MISSION STREET
STREET 2: SUITE 104
CITY: SAN FRANCISCO
STATE: CA
ZIP: 94103
BUSINESS PHONE: 415-375-3176
MAIL ADDRESS:
STREET 1: 901 MISSION STREET
STREET 2: SUITE 104
CITY: SAN FRANCISCO
STATE: CA
ZIP: 94103
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: KHOSLA VINOD
CENTRAL INDEX KEY: 0001032453
STATE OF INCORPORATION: CA
FISCAL YEAR END: 1231
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-37622
FILM NUMBER: 151253483
MAIL ADDRESS:
STREET 1: 1760 THE ALAMEDA #300
CITY: SAN JOSE
STATE: CA
ZIP: 95126
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: VK Services, LLC
CENTRAL INDEX KEY: 0001501927
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-37622
FILM NUMBER: 151253484
BUSINESS ADDRESS:
STREET 1: 3000 SAND HILL ROAD
STREET 2: BUILDING 3, SUITE 190
CITY: MENLO PARK
STATE: CA
ZIP: 94025
BUSINESS PHONE: (650) 376-8510
MAIL ADDRESS:
STREET 1: 3000 SAND HILL ROAD
STREET 2: BUILDING 3, SUITE 190
CITY: MENLO PARK
STATE: CA
ZIP: 94025
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Khosla Ventures Associates III, LLC
CENTRAL INDEX KEY: 0001501934
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-37622
FILM NUMBER: 151253485
BUSINESS ADDRESS:
STREET 1: 3000 SAND HILL ROAD
STREET 2: BUILDING 3, SUITE 190
CITY: MENLO PARK
STATE: CA
ZIP: 94025
BUSINESS PHONE: (650) 376-8510
MAIL ADDRESS:
STREET 1: 3000 SAND HILL ROAD
STREET 2: BUILDING 3, SUITE 190
CITY: MENLO PARK
STATE: CA
ZIP: 94025
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Khosla Ventures III, L.P.
CENTRAL INDEX KEY: 0001471809
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-37622
FILM NUMBER: 151253486
BUSINESS ADDRESS:
STREET 1: 3000 SAND HILL ROAD
STREET 2: BUILDING 3, SUITE 170
CITY: MENLO PARK
STATE: CA
ZIP: 94025
BUSINESS PHONE: (650) 376-8510
MAIL ADDRESS:
STREET 1: 3000 SAND HILL ROAD
STREET 2: BUILDING 3, SUITE 170
CITY: MENLO PARK
STATE: CA
ZIP: 94025
4
1
doc4.xml
FORM 4 SUBMISSION
X0306
4
2015-11-24
0
0001512673
Square, Inc.
SQ
0001471809
Khosla Ventures III, L.P.
2128 SAND HILL ROAD
MENLO PARK
CA
94025
0
0
1
0
0001501934
Khosla Ventures Associates III, LLC
2128 SAND HILL ROAD
MENLO PARK
CA
94025
0
0
1
0
0001501927
VK Services, LLC
2128 SAND HILL ROAD
MENLO PARK
CA
94025
0
0
1
0
0001032453
KHOSLA VINOD
2128 SAND HILL ROAD
MENLO PARK
CA
94025
0
0
1
0
Common Stock
2015-11-24
4
C
0
41614640
A
41614640
I
See footnote
Common Stock
2015-11-24
4
C
0
6321120
A
6321120
I
See footnote
Common Stock
2015-11-24
4
C
0
2587020
A
2587020
I
See footnote
Common Stock
2015-11-24
4
J
0
50522780
D
0
I
See footnote
Series A Preferred Stock
2015-11-24
4
C
0
41614640
0.00
D
Common Stock
41614640
0
I
See footnote
Series B-2 Preferred Stock
2015-11-24
4
C
0
6321120
0.00
D
Common Stock
6321120
0
I
See footnote
Series C Preferred Stock
2015-11-24
4
C
0
2587020
0.00
D
Common Stock
2587020
0
I
See footnote
Class B Common Stock
2015-11-24
4
J
0
50522780
0.00
A
Class A Common Stock
50522780
50522780
I
See footnote
The Series A Preferred Stock automatically converted into Common Stock on a 1:1 basis immediately prior to the closing of the Issuer's initial public offering and had no expiration date.
The Series B-2 Preferred Stock automatically converted into Common Stock on a 1:1 basis immediately prior to the closing of the Issuer's initial public offering and had no expiration date.
The Series C Preferred Stock automatically converted into Common Stock on a 1:1 basis immediately prior to the closing of the Issuer's initial public offering and had no expiration date.
Consists of securities held of record by Khosla Ventures III, L.P. ("KV III"), of which Khosla Ventures Associates III, LLC ("KVA III") is the general partner. Vinod Khosla is the managing member of VK Services, LLC ("VK Services"), which is the manager of KVA III. Each of KVA III, VK Services and Vinod Khosla may be deemed to possess voting and investment control over such shares, and each of KVA III, VK Services and Vinod Khosla may be deemed to have indirect beneficial ownership of such shares. Each Reporting Person disclaims beneficial ownership of such shares except to the extent of his or its pecuniary interest therein.
Immediately prior to the closing of the Issuer's initial public offering and following the conversion of each series of the Issuer's convertible preferred stock into Common Stock, each share of Common Stock was reclassified into one share of Class B Common Stock in an exempt transaction pursuant to Rule 16b-7.
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.
/s/ Tamara L. Tompkins, as attorney in fact for Vinod Khosla, as Managing Member of VK Services, LLC, in its capacity as Manager of Khosla Ventures Associates III, LLC, in its capacity as general partner of Khosla Ventures III, L.P.
2015-11-24
/s/ Tamara L. Tompkins, as attorney in fact for Vinod Khosla, as Managing Member of VK Services, LLC, in its capacity as Manager of Khosla Ventures Associates III, LLC
2015-11-24
/s/ Tamara L. Tompkins, as attorney in fact for Vinod Khosla, as Managing Member of VK Services, LLC
2015-11-24
/s/ Tamara L. Tompkins, as attorney in fact for Vinod Khosla
2015-11-24