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Block, Inc. — Director's Dealing 2017
Feb 3, 2017
30034_dirs_2017-02-03_294c3b81-bf97-4f52-aa8e-7bc8d1455135.zip
Director's Dealing
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SEC Form 4 — Statement of Changes in Beneficial Ownership
Issuer: Square, Inc. (SQ)
CIK: 0001512673
Period of Report: 2017-02-01
Reporting Person: Dorsey Jack (Director, President, CEO & Chairman, 10% Owner)
Non-Derivative Transactions
| Date | Security | Code | Shares | Price | A/D | Holdings After | Ownership |
|---|---|---|---|---|---|---|---|
| 2017-02-01 | Class A Common Stock | C | 7200 | $0.00 | Acquired | 7200 | Indirect |
| 2017-02-01 | Class A Common Stock | G | 7200 | $0.00 | Disposed | 0 | Indirect |
Derivative Transactions
| Date | Security | Exercise Price | Code | Shares | A/D | Expiration | Underlying | Ownership |
|---|---|---|---|---|---|---|---|---|
| 2017-02-01 | Class B Common Stock | $ | C | 7200 | Disposed | Class A Common Stock (7200) | Indirect |
Holdings (Derivative)
| Security | Exercise Price | Expiration | Underlying | Shares | Ownership |
|---|---|---|---|---|---|
| Class B Common Stock | $ | Class A Common Stock (7952826) | 7952826 | Indirect | |
| Class B Common Stock | $ | Class A Common Stock (503500) | 503500 | Indirect |
Footnotes
F1: Represents the conversion of Class B Common Stock into Class A Common Stock held of record by the Jack Dorsey Revocable Trust u/a/d 12/8/10, for which the Reporting Person serves as Trustee.
F2: The shares are held of record by the Jack Dorsey Revocable Trust u/a/d 12/8/10.
F3: 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.
F4: The shares are held of record by the Jack Dorsey Remainder Trust u/a/d 6/23/10, for which the Reporting Person serves as Trustee.
F5: The shares are held of record by Start Small, LLC, for which the Reporting Person is the sole member.