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Block, Inc. — Director's Dealing 2022
May 15, 2022
30034_rns_2022-05-15_6001e532-9ed7-4d59-9743-baec0f541a2d.pdf
Director's Dealing
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5/13/22, 2:27 PM
SEC FORM 4
SEC Form 4
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
FORM 4
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| OMB Number: 3235-0287 |
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Washington, D.C. 20549
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| OMB Number: 3235-0287 |
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| STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 or Section 30(h) of the Investment Company Act of 1940 Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue.See Instruction 1(b). |
Estimated average burden hours per response: 0.5 |
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| 1. Name and Address of Reporting Person* Grassadonia Brian (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) Cash App Lead |
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| 3. Date of Earliest Transaction (Month/Day/Year) 05/11/2022 |
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| 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 |
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| Table I - Non- | Derivative 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) |
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| Code | V | Amount | (A) or (D) |
Price | ||||||||||||||||||||||||
| Class A Common Stock | 05/ | 11/2022 | C (1) |
84,300 | A | $ 0.00 | 261,380 | D | ||||||||||||||||||||
| Table II - | Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) |
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| 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) |
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| Code | V | (A) | (D) | Date Exercisable |
Expiration Date |
Title | Amount or Number of Shares |
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| Stock Option (right to buy) |
$ 7.254 | 05/11/2022 | M | 84,300 | (2) | 02/27/2024 | Class B | 84,300 | $ 0.00 | 252,816 | D | |||||||||||||||||
| Common |
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| Stock (3) |
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| Class B Common Stock (3) |
(3) | 05/11/2022 | M | 84,300 | (3) | (3) | Class A | 84,300 | D | |||||||||||||||||||
| Common | $ 0.00 | 84,300 | ||||||||||||||||||||||||||
| Stock | ||||||||||||||||||||||||||||
| Class B Common Stock (3) |
(3) | 05/11/2022 | C (1) |
84,300 | (3) | (3) | Class A | 84,300 | D | |||||||||||||||||||
| Common | $ 0.00 | 0 | ||||||||||||||||||||||||||
| Stock |
Explanation of Responses:
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Represents the conversion of Class B Common Stock into Class A Common Stock held of record by the Reporting Person.
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20% of the shares subject to the option vested on February 24, 2015 and 1/60th of the shares vested monthly thereafter.
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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
05/13/2022
** 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/1512673/000120919122028918/xslF345X03/doc4.xml
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