0001209191-24-000841.txt : 20240104 0001209191-24-000841.hdr.sgml : 20240104 20240104170309 ACCESSION NUMBER: 0001209191-24-000841 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20240102 FILED AS OF DATE: 20240104 DATE AS OF CHANGE: 20240104 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: BOTHA ROELOF CENTRAL INDEX KEY: 0001222287 ORGANIZATION NAME: FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-37622 FILM NUMBER: 24513042 MAIL ADDRESS: STREET 1: C/O SEQUOIA CAPITAL STREET 2: 2800 SAND HILL RD, SUITE 101 CITY: MENLO PARK STATE: CA ZIP: 94025 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Block, Inc. CENTRAL INDEX KEY: 0001512673 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-PREPACKAGED SOFTWARE [7372] ORGANIZATION NAME: 06 Technology IRS NUMBER: 800429876 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 1455 MARKET STREET STREET 2: SUITE 600 CITY: SAN FRANCISCO STATE: CA ZIP: 94103 BUSINESS PHONE: 415-375-3176 MAIL ADDRESS: STREET 1: 1455 MARKET STREET STREET 2: SUITE 600 CITY: SAN FRANCISCO STATE: CA ZIP: 94103 FORMER COMPANY: FORMER CONFORMED NAME: Square, Inc. DATE OF NAME CHANGE: 20110210 4 1 doc4.xml FORM 4 SUBMISSION X0508 4 2024-01-02 0 0001512673 Block, Inc. SQ 0001222287 BOTHA ROELOF C/O SEQUOIA CAPITAL, 2800 SAND HILL ROAD SUITE 101 MENLO PARK CA 94025 1 0 0 0 0 Class A Common Stock 2024-01-02 4 A 0 177 0.00 A 24221 D Class A Common Stock 1862 I Sequoia Capital U.S. Growth Fund IV, L.P. Class A Common Stock 77 I Sequoia Capital USGF Principals Fund IV, L.P. Class A Common Stock 684741 I By estate planning vehicle Class A Common Stock 11388 I Sequoia Capital U.S. Venture Fund XV, L.P. Class A Common Stock 479 I Sequoia Capital U.S. Venture Partners Fund XV (Q), L.P. Class A Common Stock 171 I Sequoia Capital U.S. Venture Partners Fund XV, L.P. Class A Common Stock 1750 I Sequoia Capital U.S. Venture XV Principals Fund, L.P. Class A Common Stock 540646 I Sequoia Capital US/E Expansion Fund I, L.P. Each 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. The Reporting Person is a director and stockholder of SC US (TTGP), Ltd. 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 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. The Reporting Person is a director and stockholder of SC US (TTGP), Ltd. SC US (TTGP), Ltd. is the general partner of SC U.S. Venture XV Management, L.P., which is the general partner of Sequoia Capital U.S. Venture Fund XV, L.P., Sequoia Capital U.S. Venture Partners Fund XV (Q), L.P., Sequoia Capital U.S. Venture Partners Fund XV, L.P. and Sequoia Capital U.S. Venture XV Principals Fund, L.P., or collectively, the SC USV XV Funds. The Reporting Person disclaims beneficial ownership of the securities held by the SC USV XV 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. The Reporting Person is a director and stockholder of SC US (TTGP), Ltd. SC US (TTGP), Ltd. is the general partner of SC US/E Expansion Fund I Management, L.P., which is the general partner of Sequoia Capital US/E Expansion Fund I, L.P. The Reporting Person disclaims beneficial ownership of the securities held by SC US/E Expansion Fund I Management, L.P. 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. /s/ Susan Szotek, Attorney-in-Fact 2024-01-04