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Block, Inc. Director's Dealing 2023

Apr 5, 2023

30034_rns_2023-04-05_523d666f-01cc-40ed-b2e5-bb01dafde6ee.pdf

Director's Dealing

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4/5/23, 2:32 PM

SEC FORM 4

SEC Form 4

FORM 4

UNITED STATES SECURITIES AND EXCHANGE COMMISSION

OMB APPROVAL

Washington, D.C. 20549

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

STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP

Check this box if no longer subject to
Section 16. Form 4 or Form 5
Check this box if no longer subject to
Section 16. Form 4 or Form 5
Check this box if no longer subject to
Section 16. Form 4 or Form 5
STAT EMENT OF CHA GES IN BENEFICIAL OWN RS IP
hours per response:
0.5
obligations may continue.See
Instruction 1(b). 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*
McKelvey James Morgan Jr.
2. Issuer NameandTicker or Trading Symbol
Block, Inc. [
SQ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X
Director
10% Owner
(Last)
(First)
(Middle) 3. Date of Earliest Transaction (Month/Day/Year)
04/03/2023
Officer (give title
below)
Other (specify
below)
1955 BROADWAY 4. If Amendment, Date of Original Filed (Month/Day/Year) 6. Individual or Joint/Group Filing (Check Applicable
SUITE 600 Line)
X
Form filed by One Reporting Person
(Street) Form filed by More than One Reporting
Person
OAKLAND
CA
94612
Rule 10b5-1(c) Transaction Indication
(City)
(State)
(Zip) Check this box to indicate that a transaction was made pursuant to a contract, instruction or written plan that is intended to satisfy
the affirmative defense conditions of Rule 10b5-1(c). See Instruction 10.

Check this box to indicate that a transaction was made pursuant to a contract, instruction or written plan that is intended to satisfy the affirmative defense conditions of Rule 10b5-1(c). See Instruction 10.

Table I - Non-Derivative Securities Table I - Non-Derivative Securities Table I - Non-Derivative Securities Table I - Non-Derivative Securities Table I - Non-Derivative Securities Acquired, Acquired, Disposed of, or Beneficially Owned Disposed of, or Beneficially Owned Disposed of, or Beneficially Owned Disposed of, or Beneficially Owned Disposed of, or Beneficially Owned Disposed of, or Beneficially Owned Disposed of, or Beneficially Owned
1. Title of Security (Instr. 3) 2. Transaction 2A. Deemed 3. 4. Securities Acquired (A) or 5. Amount of 6. Ownership 7. Nature of
Date Execution Date, Transaction Disposed Of (D) (Instr. 3, 4 and Securities Form: Direct Indirect
(Month/Day/Year) if any Code (Instr. 5) Beneficially (D) or Indirect Beneficial
(Month/Day/Year) 8) Owned Following (I) (Instr. 4) Ownership
Reported (Instr. 4)
Code V Amount
(A) or
(D)
Price
Transaction(s)
(Instr. 3 and 4)
Class A Common Stock 04/03/2023 A 145
(1)
A
$ 0.00
6,023 D
Class A Common Stock 125,000 I See
Footnote
(2)
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of 2. 3. Transaction 3A. Deemed 4. 5. 6. Date Exercisable and 7. Title and Amount of 8. Price of 9. Number of 10. 11. Nature
Derivative Conversion Date Execution Date, Transaction Number Expiration Date Securities Underlying Derivative derivative Ownership of Indirect
Security or Exercise (Month/Day/Year) if any Code (Instr. of (Month/Day/Year) Derivative Security Security Securities Form: Beneficial
(Instr. 3) Price of (Month/Day/Year) 8) Derivative (Instr. 3 and 4) (Instr. 5) Beneficially Direct (D) Ownership
Derivative Securities Owned or Indirect (Instr. 4)
Security Acquired Following (I) (Instr. 4)
(A) or Reported
Disposed Transaction(s)
of (D) (Instr. 4)
(Instr. 3, 4
and 5)
Amount or
Date Expiration Number of
Code V (A)
(D)
Exercisable Date Title Shares
Class B
Common
Stock
(3)
(3) (3) (3) Class A
Common
Stock
12,259,025
12,259,025 I See
Footnote
(4)

Explanation of Responses:

  1. Each share is represented by a restricted stock unit (RSU). Each RSU represents a contingent right to receive one share of the Issuer's Class A Common Stock upon settlement. The RSUs were issued pursuant to the Issuer's Outside Director Compensation Policy, and 100% of the RSUs were vested as of the date of grant.

  2. The shares are held by the Anna Elefteria Ntenta Trust, dated 11/30/2017, for the benefit of the Reporting Person's spouse.

  3. 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.

  4. The shares are held of record by the James McKelvey, Jr. Revocable Trust dated July 2, 2014, for which the Reporting Person serves as a Trustee.

Remarks:

/s/ Susan Szotek, Attorney-in04/05/2023 Fact ** 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/1512673/000120919123023404/xslF345X04/doc4.xml

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