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Block, Inc. Director's Dealing 2022

Mar 13, 2022

30034_rns_2022-03-13_aab1b094-de7b-4503-8deb-a0f7b3c9753a.pdf

Director's Dealing

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3/11/22, 2:38 PM

SEC FORM 4

SEC Form 4

UNITED STATES SECURITIES AND EXCHANGE COMMISSION

FORM 4

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

Washington, D.C. 20549

OMB APPROVAL OMB APPROVAL OMB APPROVAL OMB APPROVAL OMB APPROVAL OMB APPROVAL
OMB Number:
3235-0287
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
1. Name and Address of Reporting Person*
VINIAR DAVID A
(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]
3. Date of Earliest Transaction (Month/Day/Year)
02/01/2022
4. If Amendment, Date of Original Filed (Month/Day/Year)
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X
Director
10% Owner
Officer (give title
below)
Other (specify
below)
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- 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)
Code V Amount (A) or
(D)
Price
Class A Common Stock 02/01/2022 A 72
(1)
A $ 0.00 72 I
(2)
(3)
See
Footnote
Class A Common Stock 73,398 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
Class B
Common
Stock
(4)
(4) (4) (4) Class A 26,250 D
Common 26,250
Stock

Explanation of Responses:

  1. Received in exchange for 193 ordinary shares of Afterpay Limited in connection with a merger of Afterpay Limited into an indirect wholly-owned subsidiary of the Issuer.

  2. Shares are held of record by Viniar Family LLC, for which the Reporting Person serves as the managing member.

  3. Represents ownership of CHESS Depositary Interests ("CDIs"), each representing an ownership interest in a share of Class A common stock of the Issuer.

  4. 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

03/11/2022

** 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/1090352/000120919122018245/xslF345X03/doc4.xml

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