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Block, Inc. Director's Dealing 2022

Jun 5, 2022

30034_rns_2022-06-05_24da1a68-ec43-4b9a-9057-5192bb2b4f88.pdf

Director's Dealing

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6/3/22, 1:37 PM

SEC FORM 4

SEC Form 4 FORM 4

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

OMB APPROVAL

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

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

File

Instruction 1(b).
d 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*
Whiteley Sivan
(Last)
(First)
(Middle)
1455 MARKET STREET
SUITE 600
(Street)
SAN FRANCISCO
CA
94103
(City)
(State)
(Zip)
2. Issuer NameandTicker or Trading Symbol
Block, Inc. [
SQ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director
10% Owner
X
Officer (give title
below)
Other (specify
below)
Chief Legal Ofcr. & Corp. Sec.
3. Date of Earliest Transaction (Month/Day/Year)
06/01/2022
4. If Amendment, Date of Original Filed (Month/Day/Year) 6. Individual or Joint/Group Filing (Check Applicable
Line)
X
Form filed by One Reporting Person
Form filed by More than One Reporting Person
Table I - Non-D erivative Securities Acquired, Disposed of, or Beneficially Owned
1. Title of Security (Instr. 3) 2. Transaction
Date
(Month/Day/Year)
2A. Deemed
Execution Date,
if any
(Month/Day/Year)
3.
Transaction
Code (Instr.
8)
4. Securities Acquired (A) or
Disposed Of (D) (Instr. 3, 4
and 5)
5. Amount of
Securities
Beneficially
Owned Following
Reported
Transaction(s)
(Instr. 3 and 4)
6. Ownership
Form: Direct
(D) or Indirect
(I) (Instr. 4)
7. Nature
of Indirect
Beneficial
Ownership
(Instr. 4)
Code V Amount (A) or
(D)
Price
Class A Common Stock 05/13/2022 A V 107
(1)
A $ 71.53 116,465 D
Class A Common Stock 06/01/2022 F 103
(2)
D $ 81.91 116,362 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
or Exercise
Price of
Derivative
Security
3. Transaction
Date
(Month/Day/Year)
3A. Deemed
Execution Date,
if any
(Month/Day/Year)
4.
Transaction
Code (Instr.
8)
5.
Number
of
Derivative
Securities
Acquired
(A) or
Disposed
of (D)
(Instr. 3, 4
and 5)
6. Date Exercisable and
Expiration Date
(Month/Day/Year)
7. Title and
Amount of
Securities
Underlying
Derivative
Security
(Instr. 3 and
4)
8. Price of
Derivative
Security
(Instr. 5)
9. Number of
derivative
Securities
Beneficially
Owned
Following
Reported
Transaction(s)
(Instr. 4)
10.
Ownership
Form:
Direct (D)
or Indirect
(I) (Instr. 4)
11. Nature
of Indirect
Beneficial
Ownership
(Instr. 4)
Code V (A) (D) Date
Exercisable
Expiration
Date
Title Amount
or
Number
of
Shares

Explanation of Responses:

  1. These shares were acquired under the Issuer's Employee Stock Purchase Plan in a transaction that was exempt under both Rule 16b-3(d) and Rule 16b-3(c).

  2. Represents shares that have been withheld by the Issuer to satisfy its income tax and withholding and remittance obligations in connection with the net settlement of restricted stock units and does not represent a sale by the Reporting Person.

Remarks:

/s/ Susan Szotek, Attorney-in-Fact

06/03/2022

** 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.

https://www.sec.gov/Archives/edgar/data/1512673/000120919122034075/xslF345X03/doc4.xml

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