0001209191-17-046474.txt : 20170727 0001209191-17-046474.hdr.sgml : 20170727 20170727181938 ACCESSION NUMBER: 0001209191-17-046474 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20170725 FILED AS OF DATE: 20170727 DATE AS OF CHANGE: 20170727 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Friar Sarah CENTRAL INDEX KEY: 0001570658 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-37622 FILM NUMBER: 17987365 MAIL ADDRESS: STREET 1: C/O MODEL N, INC. STREET 2: 1800 BRIDGE PARKWAY CITY: REDWOOD CITY STATE: CA ZIP: 94065 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 4 1 doc4.xml FORM 4 SUBMISSION X0306 4 2017-07-25 0 0001512673 Square, Inc. SQ 0001570658 Friar Sarah 1455 MARKET STREET SUITE 600 SAN FRANCISCO CA 94103 0 1 0 0 Chief Financial Officer Class A Common Stock 2017-07-25 4 F 0 2688 26.89 D 366103 D Class B Common Stock Class A Common Stock 331135 331135 I See Footnote Class B Common Stock Class A Common Stock 825634 825634 I See Footnote Represents shares that have been withheld by the Issuer to satisfy its income tax and withholding and remittance obligations in connection with the net settlement of restricted stock units and does not represent a sale 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 David Riley and Sarah Friar Revocable Trust dated August 11, 2006 (Revocable Trust), for which the Reporting Person serves as a trustee. The Reporting Person has sole dispositive power and voting control over the shares of the Issuer held by the Revocable Trust. The shares are held of record by The Sarah Friar 2015 GRAT, dated August 6, 2015, for which the Reporting Person serves as a trustee. /s/ Jason Gao, Attorney-in-Fact 2017-07-27