0001209191-17-003239.txt : 20170110 0001209191-17-003239.hdr.sgml : 20170110 20170110172754 ACCESSION NUMBER: 0001209191-17-003239 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20170106 FILED AS OF DATE: 20170110 DATE AS OF CHANGE: 20170110 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: 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 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Summers Lawrence Henry CENTRAL INDEX KEY: 0001626636 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-37622 FILM NUMBER: 17521470 MAIL ADDRESS: STREET 1: 207 FISHER AVENUE CITY: BROOKLINE STATE: MA ZIP: 02445 4 1 doc4.xml FORM 4 SUBMISSION X0306 4 2017-01-06 0 0001512673 Square, Inc. SQ 0001626636 Summers Lawrence Henry 1455 MARKET STREET SUITE 600 SAN FRANCISCO CA 94103 1 0 0 0 Class A Common Stock 2017-01-06 4 C 0 23125 0.00 A 50507 D Class A Common Stock 2017-01-06 4 S 0 23125 15.00 D 27382 D Class B Common Stock 2017-01-06 4 C 0 23125 0.00 D Class A Common Stock 23125 0 D Class B Common Stock Class A Common Stock 57818 57818 I See footnote Class B Common Stock Class A Common Stock 740679 740679 I See footnote Represents the conversion of Class B Common Stock into Class A Common Stock held of record by the Reporting Person. 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. The shares are held of record by the LHS 2015 Qualified Annuity Trust #2S dated March 26, 2015, for which the Reporting Person serves as trustee. The shares are held of record by the LHS 2016 Qualified Annuity Trust - Square, for which the Reporting Person serves as trustee. /s/ Laura Reis, Attorney-in-Fact 2017-01-10