Block, Inc. — Director's Dealing 2022

Feb 2, 2022

2/2/22, 2:05 PM

SEC FORM 3

SEC Form 3

FORM 3

UNITED STATES SECURITIES AND EXCHANGE COMMISSION

Washington, D.C. 20549

INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES

OMB APPROVAL OMB 3235Number: 0104 Estimated average burden hours per 0.5 response:

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	1. Name and Address of Reporting	2. Date of Event	3. Issuer NameandTicker or Trading Symbol	3. Issuer NameandTicker or Trading Symbol	3. Issuer NameandTicker or Trading Symbol
Person*		Requiring Statement	Block, Inc. [ SQ]
Rothstein Sharon		(Month/Day/Year)
(Last) (First) (Middle) 1455 MARKET STREET SUITE 600 (Street)		01/31/2022	4. Relationship of Reporting Person(s) to Issuer (Check all applicable) X Director 10% Owner Officer (give title below) Other (specify below)		5. 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
SAN FRANCISCO CA	94103				Form filed by More than One Reporting Person
(City) (State)	(Zip)

Table I - Non-Derivative Securities Beneficially Owned

1. Title of Security (Instr. 4) 2. Amount of	1. Title of Security (Instr. 4) 2. Amount of	3.		4. Nature of Indirect Beneficial
Securities Beneficially		Ownership		Ownership (Instr. 5)
Owned	(Instr. 4)	Form:
		Direct (D)
		or Indirect
		(I) (Instr. 5)
Class A Common Stock	1,256 (1)	D

Table II - Derivative Securities Beneficially Owned

	(e.g., puts,	calls, warrants, options, convertible	calls, warrants, options, convertible	securities)
1. Title of Derivative Security	2. Date Exercisable and		3. Title and Amount of	4.	5.	6. Nature of
(Instr. 4)	Expiration Date		Securities Underlying	Conversion	Ownership	Indirect
	(Month/Day/Year)		Derivative Security (Instr.	or Exercise	Form:	Beneficial
			4)	Price of	Direct (D)	Ownership
			Amount	Derivative Security	or Indirect (I) (Instr. 5)	(Instr. 5)
			or
			Number
	Date	Expiration	of
	Exercisable	Date	Title Shares

Explanation of Responses:

1. Represents ownership of CHESS Depositary Interests ("CDIs"), each representing an ownership interest in a share of Class A common stock of Block, Inc. ("Block"). As of January 31, 2022 (Pacific Standard Time), the Reporting Person held 3,350 American Depositary Shares, each representing one ordinary share of Afterpay Limited ("Afterpay"). On January 31, 2022 (Pacific Standard Time), each ordinary share of Afterpay was converted into the right to receive 0.375 shares of Block Class A common stock (or CDIs) as a result of Block's indirect acquisition of Afterpay in accordance with the Scheme Implementation Deed between Block, Lanai (AU) 2 Pty Ltd, and Afterpay, dated August 2, 2021 (Australian Eastern Standard Time), as amended December 7, 2021 (Australian Eastern Daylight Time).

Remarks:

/s/ Susan Szotek, 02/02/2022 Attorney-in-Fact

** Signature of Reporting Person

Date

https://www.sec.gov/Archives/edgar/data/1512673/000120919122006426/xslF345X02/doc3.xml

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2/2/22, 2:05 PM

SEC FORM 3

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 5 (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/1512673/000120919122006426/xslF345X02/doc3.xml

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