Block, Inc. — Director's Dealing 2022

Aug 28, 2022

SEC Form 4

FORM 4

OMB APPROVAL

OMB Number: 3235-0287 Estimated average burden hours per response: 0.5

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UNITED STATES SECURITIES AND EXCHANGE COMMISSION

Washington, D.C. 20549

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

STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP

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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
1. Name and Address of Reporting Person [] 2. Issuer Name and Ticker or Trading Symbol 5. Relationship of Reporting Person(s) to Issuer
Block, Inc. [ SQ ] (Check all applicable)
Henry Alyssa Director 10% Owner
3. Date of Earliest Transaction (Month/Day/Year) X Officer (give title below) Other (specify below)
08/24/2022
(Last) (First) (Middle) Square Lead
1455 MARKET STREET
4. If Amendment, Date of Original Filed (Month/Day/Year) 6. Individual or Joint/Group Filing (Check Applicable Line)
SUITE 600
X Form filed by One Reporting Person
Form filed by More than One Reporting Person
(Street)
SAN FRANCISCO CA 94103
(City) (State) (Zip)
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
1. Title of Security (Instr. 3) 2. Transaction 2A. Deemed 3. Transaction Code 4. Securities Acquired (A) or Disposed Of (D) (Instr. 3, 4 and 5. Amount of Securities 6. Ownership Form: Direct 7. Nature of Indirect
Date Execution Date, (Instr. 8) 5) Beneficially Owned Following (D) or Indirect (I) (Instr. 4) Beneficial
(Month/Day/Year) if any Reported Transaction(s) (Instr. 3 Ownership (Instr. 4)
(Month/Day/Year) Code V Amount (A) or (D) Price and 4)
Class A Common Stock 08/24/2022 C(1) 30,769 A $0.00 458,827 D
Class A Common Stock 08/24/2022 S(2) 30,169 D $72.08(3) 428,658 D
Class A Common Stock 08/24/2022 S(2) 600 D $72.52(4) 428,058 D
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 3) 2. Conversion 3. Transaction 3A. Deemed 4. Transaction Code 5. Number of Derivative 6. Date Exercisable and 7. Title and Amount of Securities Underlying 8. Price of 9. Number of 10. Ownership 11. Nature of Indirect
or Exercise Date Execution Date, (Instr. 8) Securities Acquired (A) or Expiration Date Derivative Security (Instr. 3 and 4) Derivative derivative Form: Direct (D) Beneficial
Price of (Month/Day/Year) if any Disposed of (D) (Instr. 3, 4 and (Month/Day/Year) Security (Instr. 5) Securities or Indirect (I) Ownership (Instr. 4)
Derivative (Month/Day/Year) 5) Beneficially (Instr. 4)
Security Owned Following
Reported
Date Expiration Amount or Number Transaction(s)
Code V (A) (D) Exercisable Date Title of Shares (Instr. 4)
Stock Option (right to buy) $7.254 08/24/2022 M(2) 30,769 (5) 05/14/2024 Class B Common Stock(6) 30,769 $0.00 1,107,684 D
Class B Common Stock(6) (6) 08/24/2022 M 30,769 (6) (6) Class A Common Stock 30,769 $0.00 30,769 D
Class B Common Stock(6) (6) 08/24/2022 C(1) 30,769 (6) (6) Class A Common Stock 30,769 $0.00 0 D
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Explanation of Responses:

1. Represents the conversion of Class B Common Stock into Class A Common Stock held of record by the Reporting Person.

2. The option exercise and sales reported on this Form 4 were effected pursuant to a Rule 10b5-1 trading plan.

3. The reported price in Column 4 is a weighted average sale price. These shares were sold in multiple transactions at prices ranging from $71.50 to $72.49 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.

4. The reported price in Column 4 is a weighted average sale price. These shares were sold in multiple transactions at prices ranging from $72.50 to $72.54 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.

5. 25% of the shares subject to the option vested on May 12, 2015 and 1/48th of the shares vested monthly thereafter.

6. 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.

Remarks:

/s/ Susan Szotek, Attorney-in-Fact 08/26/2022 ** Signature of Reporting Person Date

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.