# EDGAR Filing Document

**Accession Number:** 0001222287
**File Stem:** 0001628280-25-034302
**Filing Date:** 2025-7
**Character Count:** 9087
**Document Hash:** a623469a8bfbfabb7f2c5b264e0cd827
**Contains OCR:** False
**Source Format:** 

## Filing Content

## Filing Summary
**0001628280-25-034302.hdr.sgml**: 20250703

**ACCESSION NUMBER**: 0001628280-25-034302

**CONFORMED SUBMISSION TYPE**: 4

**PUBLIC DOCUMENT COUNT**: 1

**CONFORMED PERIOD OF REPORT**: 20250701

**FILED AS OF DATE**: 20250703

**DATE AS OF CHANGE**: 20250703

**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:** 251106248

**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
- **EIN:** 800429876
- **STATE OF INCORPORATION:** DE
- **FISCAL YEAR END:** 1231

**BUSINESS ADDRESS:**
- **STREET 1:** 1955 BROADWAY
- **STREET 2:** SUITE 600
- **CITY:** OAKLAND
- **STATE:** CA
- **ZIP:** 94612
- **BUSINESS PHONE:** 415-375-3176

**MAIL ADDRESS:**
- **STREET 1:** 1955 BROADWAY
- **STREET 2:** SUITE 600
- **CITY:** OAKLAND
- **STATE:** CA
- **ZIP:** 94612

**FORMER COMPANY:**
- **FORMER CONFORMED NAME:** Square, Inc.
- **DATE OF NAME CHANGE:** 20110210

### UNITED STATES SECURITIES AND EXCHANGE COMMISSION
**Washington, D.C. 20549**

## FORM 4

### STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP

[ ] Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).

[ ] Check this box to indicate that a transaction was made pursuant to a contract, instruction or written plan for the purchase or sale of equity securities of the issuer that is intended to satisfy the affirmative defense conditions of Rule 10b5-1(c). See Instruction 10.

---

| | | |
|:---|:---|:---|
| **1. Name and Address of Reporting Person**<sup>*</sup><br>BOTHA ROELOF<br><sub>(Last) (First) (Middle)</sub><br>C/O SEQUOIA CAPITAL, 2800 SAND HILL ROAD<br>SUITE 101<br><sub>(Street)</sub><br>MENLO PARK, CA 94025<br><sub>(City) (State) (Zip)</sub> | **3. Date of Earliest Transaction (Month/Day/Year)**<br>2025-07-01 | **5. Relationship of Reporting Person(s) to Issuer**<br>(Check all applicable)<br>[X] Director [ ] 10% Owner<br>[ ] Officer (give title below) [ ] Other (specify below)<br>_ _ |
| **2. Issuer Name and Ticker or Trading Symbol**<br>Block, Inc. [ XYZ ] | **4. If Amendment, Date of Original Filed (Month/Day/Year)**<br>  | **6. Individual or Joint/Group Filing (Check Applicable Line)**<br>[X] Form filed by One Reporting Person<br>[ ] Form filed by More than One Reporting Person |

---

## Table I - Non-Derivative Securities

---

|  |  |  |  |  |  |  |  |  |  |  |
| --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- |
| 1. Title of Security | 2. Transaction Date | 2A. Deemed Execution Date | 3. Transaction Code (V) | 3. Transaction Code (V) | 4. Securities Acquired (A) or Disposed of (D) | 4. Securities Acquired (A) or Disposed of (D) | 4. Securities Acquired (A) or Disposed of (D) | 5. Amount of Securities Beneficially Owned | 6. Ownership Form | 7. Nature of Indirect Beneficial Ownership |
| 1. Title of Security | 2. Transaction Date | 2A. Deemed Execution Date | Code | V | Amount | (A) or (D) | Price | 5. Amount of Securities Beneficially Owned | 6. Ownership Form | 7. Nature of Indirect Beneficial Ownership |
| Class A Common Stock | 2025-07-01 |  | A |  | 294<sup>(1)</sup> | A | $0 | 36124 | D |  |
| Class A Common Stock |  |  |  |  |  |  |  | 1862 | I | Sequoia Capital U.S. Growth Fund IV, L.P.<sup>(2)</sup> |
| Class A Common Stock |  |  |  |  |  |  |  | 77 | I | Sequoia Capital USGF Principals Fund IV, L.P.<sup>(2)</sup> |
| 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.<sup>(3)</sup> |
| Class A Common Stock |  |  |  |  |  |  |  | 479 | I | Sequoia Capital U.S. Venture Partners Fund XV (Q), L.P.<sup>(3)</sup> |
| Class A Common Stock |  |  |  |  |  |  |  | 171 | I | Sequoia Capital U.S. Venture Partners Fund XV, L.P.<sup>(3)</sup> |
| Class A Common Stock |  |  |  |  |  |  |  | 1750 | I | Sequoia Capital U.S. Venture XV Principals Fund, L.P.<sup>(3)</sup> |
| Class A  Common Stock |  |  |  |  |  |  |  | 540646 | I | Sequoia Capital US/E Expansion Fund I, L.P.<sup>(4)</sup> |
| Class A  Common Stock |  |  |  |  |  |  |  | 434405 | I | SC US/E ExpansionFund I Management, L.P.<sup>(4)</sup> |

---

## Table II - Derivative Securities

---

|  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |
| --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- |
| 1. Title of Derivative Security | 2. Conversion or Exercise Price | 3. Transaction Date | 3A. Deemed Execution Date | 4. Transaction Code (V) | 4. Transaction Code (V) | 5. Number of Derivative Securities Acquired (A) or Disposed of (D) | 5. Number of Derivative Securities Acquired (A) or Disposed of (D) | 6. Date Exercisable and Expiration Date | 6. Date Exercisable and Expiration Date | 7. Title and Amount of Underlying Securities | 7. Title and Amount of Underlying Securities | 8. Price of Derivative Security | 9. Number of Derivative Securities Beneficially Owned | 10. Ownership Form | 11. Nature of Indirect Beneficial Ownership |
| 1. Title of Derivative Security | 2. Conversion or Exercise Price | 3. Transaction Date | 3A. Deemed Execution Date | Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | 8. Price of Derivative Security | 9. Number of Derivative Securities Beneficially Owned | 10. Ownership Form | 11. Nature of Indirect Beneficial Ownership |
|  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |

---

### Footnotes:

(1) 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.

(2) 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.

(3) 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.

(4) 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., or collectively, the SC EXPI Funds. The Reporting Person disclaims beneficial ownership of the securities held by the SC EXPI 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.

**Signature:** /s/ Susan Szotek, Attorney-in-Fact  
**Date:** 2025-07-03

### Remarks:

Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.

* If the form is filed by more than one reporting person, see Instruction 4 (b)(v).

** Intentional misstatements or omissions of facts constitute Federal Criminal Violations See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a).

Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure.

**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 Number.**