Statement of Changes in Beneficial Ownership (4)
13 9월 2019 - 7:34AM
Edgar (US Regulatory)
FORM 4
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Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
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OMB APPROVAL
OMB Number:
3235-0287
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Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 or Section 30(h) of the Investment Company Act of 1940
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1. Name and Address of Reporting Person
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Henry Alyssa |
2. Issuer Name and Ticker or Trading Symbol
Square, Inc.
[
SQ
]
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
_____ Director _____ 10% Owner __X__ Officer (give title below) _____ Other (specify below) Seller Lead
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(Last)
(First)
(Middle)
1455 MARKET STREET, SUITE 600 |
3. Date of Earliest Transaction
(MM/DD/YYYY)
9/10/2019
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(Street)
SAN FRANCISCO, CA 94103
(City)
(State)
(Zip)
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4. If Amendment, Date Original Filed
(MM/DD/YYYY)
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6. Individual or Joint/Group Filing
(Check Applicable Line)
_X
_ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person
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Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
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1.Title of Security (Instr. 3)
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2. Trans. Date
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2A. Deemed Execution Date, if any
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3. Trans. Code (Instr. 8)
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4. Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5)
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5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4)
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6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)
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7. Nature of Indirect Beneficial Ownership (Instr. 4)
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Code
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V
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Amount
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(A) or (D)
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Price
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Class A Common Stock
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9/10/2019
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C(1)
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20000
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A
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$0.00
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442168
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D
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Class A Common Stock
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9/10/2019
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S(2)
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20000
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D
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$60.26 (3)
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422168
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D
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Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security (Instr. 3)
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2. Conversion or Exercise Price of Derivative Security
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3. Trans. Date
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3A. Deemed Execution Date, if any
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4. Trans. Code (Instr. 8)
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5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5)
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6. Date Exercisable and Expiration Date
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7. Title and Amount of Securities Underlying Derivative Security (Instr. 3 and 4)
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8. Price of Derivative Security (Instr. 5)
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9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4)
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10. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 4)
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11. Nature of Indirect Beneficial Ownership (Instr. 4)
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Code
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V
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(A)
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(D)
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Date Exercisable
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Expiration Date
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Title
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Amount or Number of Shares
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Stock Option (right to buy)
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$7.254
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9/10/2019
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M
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20000
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(4)
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5/14/2024
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Class B Common Stock (5)
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20000
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$0.00
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1660000
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D
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Class B Common Stock (5)
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(5)
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9/10/2019
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M
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20000
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(5)
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(5)
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Class A Common Stock
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20000
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$0.00
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20000
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D
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Class B Common Stock (5)
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(5)
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9/10/2019
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C (1)
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20000
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(5)
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(5)
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Class A Common Stock
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20000
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$0.00
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0
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D
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Explanation of Responses:
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(1)
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Represents the conversion of Class B Common Stock into Class A Common Stock held of record by the Reporting Person.
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(2)
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The sales reported on this Form 4 were effected pursuant to a Rule 10b5-1 trading plan.
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(3)
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The reported price in Column 4 is a weighted average sale price. These shares were sold in multiple transactions at prices ranging from $60.02 to $60.65 per share. The Reporting Person undertakes to provide to the Issuer, any security holder of the Issuer, or the staff of the Securities and Exchange Commission, upon request, full information regarding the number of shares sold at each separate price within the range set forth in this footnote.
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(4)
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25% of the shares subject to the option vested on May 12, 2015, and 1/48 of the shares vested monthly thereafter.
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(5)
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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.
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Reporting Owners
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Reporting Owner Name / Address
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Relationships
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Director
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10% Owner
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Officer
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Other
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Henry Alyssa 1455 MARKET STREET SUITE 600 SAN FRANCISCO, CA 94103
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Seller Lead
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Signatures
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/s/ Shahzia Rahman, Attorney-in-Fact
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9/12/2019
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**Signature of Reporting Person
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Date
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
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*
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If the form is filed by more than one reporting person, see Instruction 4(b)(v).
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**
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Intentional misstatements or omissions of facts constitute Federal Criminal Violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
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Note:
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File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure.
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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 control number.
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