Block, Inc. — Director's Dealing 2022

Jun 1, 2022

SEC Form 4 — Statement of Changes in Beneficial Ownership

Issuer: Block, Inc. (SQ)
CIK: 0001512673
Period of Report: 2022-05-27

Reporting Person: Dorsey Jack (Director, Block Head and Chairperson, 10% Owner)

Non-Derivative Transactions

Date	Security	Code	Shares	Price	A/D	Holdings After	Ownership
2022-05-27	Class A Common Stock	C	1000000	$0.00	Acquired	1000000	Indirect

Derivative Transactions

Date	Security	Exercise Price	Code	Shares	A/D	Expiration	Underlying	Ownership
2022-05-27	Class B Common Stock	$	C	1000000	Disposed		Class A Common Stock (1000000)	Indirect

Holdings (Derivative)

Security	Exercise Price	Expiration	Underlying	Shares	Ownership
Class B Common Stock	$		Class A Common Stock (12080574)	12080574	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 (the "Dorsey Revocable Trust"). This conversion was effected in connection with the contribution by the Reporting Person of 1,000,000 shares of Class A Common Stock from the Dorsey Revocable Trust to The Jack Dorsey 2022 Annuity Trust, a grantor retained annuity trust for which the Reporting Person serves as Co-Trustee (the "Dorsey Annuity Trust"), which contribution is exempt from Section 16 of the Securities Exchange Act of 1934, as amended (the "Exchange Act"), pursuant to Rule 16a-13 under the Exchange Act.

F2: The shares are held of record by the Dorsey Annuity Trust.

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 Revocable Trust u/a/d 12/8/10, for which the Reporting Person serves as a Trustee.

F5: The shares are held of record by Start Small, LLC, for which the Reporting Person is the sole member.