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Block, Inc. — Director's Dealing 2023
Jan 5, 2023
30034_rns_2023-01-05_784d3fde-72b4-4ecd-b2e0-798a54aabc30.pdf
Director's Dealing
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1/5/23, 2:47 PM
SEC FORM 4
SEC Form 4 FORM 4
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
OMB APPROVAL OMB Number: 3235-0287 Estimated average burden hours per response: 0.5
Washington, D.C. 20549
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
Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 or Section 30(h) of the Investment Company Act of 1940
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Name and Address of Reporting Person[[*]]
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Name and Address of Reporting Person[[]] 2. Issuer Name and* Ticker or Trading Symbol Block, Inc. [ SQ ]
Dale Ajmere
- Relationship of Reporting Person(s) to Issuer (Check all applicable)
Director 10% Owner X Officer (give title Other (specify below) below)
| X | ||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| (Last) | (First) | (Middle) | 3. Date of Earliest Transaction | (Month/Day/Year) | below) | below) | ||||||||||||||
| 1455 MARKET STREET | 01/03/2023 | Chief Accounting Offcer | ||||||||||||||||||
| SUITE 600 | ||||||||||||||||||||
| 4. If Amendment, Date of | Original | Filed | (Month/Day/Year) | 6. Individual or Joint/Group Filing (Check Applicable | ||||||||||||||||
| (Street) | Line) | |||||||||||||||||||
| SAN FRANCISCO CA |
94103 | X | Form filed by One | Reporting Person | ||||||||||||||||
| Form filed by More than One Reporting | ||||||||||||||||||||
| Person | ||||||||||||||||||||
| (City) | (State) | (Zip) | ||||||||||||||||||
| Table I - Non-Derivative Securities Acquired, | 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 | |||||||||||||
| Date | Execution Date, | Transaction | Disposed | Of (D) (Instr. 3, 4 | Securities | Form: | Direct | of Indirect | ||||||||||||
| (Month/Day/Year) | if any | Code | (Instr. | and 5) | Beneficially | (D) or | Beneficial | |||||||||||||
| (Month/Day/Year) | 8) | Owned | Indirect (I) | Ownership | ||||||||||||||||
| Following | (Instr. | 4) | (Instr. 4) | |||||||||||||||||
| Code | V | Amount | (A) or (D) |
Price | Reported Transaction(s) (Instr. 3 and 4) |
|||||||||||||||
| Class A Common Stock | 11/15/2022 | A | V | 2 (1) |
A | $ 62.37 | 47,924 | D | ||||||||||||
| Class A Common Stock | 01/03/2023 | S | 1,032 (2) |
D | $ 64.28 | 46,892 | D |
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 | 6. Date Exercisable and | 7. Title and | 8. Price of | 9. Number of | 10. | 11. Nature | |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Derivative | Conversion | Date | Execution Date, | Transaction | Number | Expiration Date | Amount of | Derivative | derivative | Ownership | of Indirect | ||
| Security | or Exercise | (Month/Day/Year) | if any | Code | (Instr. | of | (Month/Day/Year) | Securities | Security | Securities | Form: | Beneficial | |
| (Instr. 3) | Price of | (Month/Day/Year) | 8) | Derivative | Underlying | (Instr. 5) | Beneficially | Direct (D) | Ownership | ||||
| Derivative | Securities | Derivative | Owned | or Indirect | (Instr. 4) | ||||||||
| Security | Acquired | Security | Following | (I) (Instr. 4) | |||||||||
| (A) or | (Instr. 3 and | Reported | |||||||||||
| Disposed | 4) | Transaction(s) | |||||||||||
| of (D) | (Instr. 4) | ||||||||||||
| (Instr. 3, 4 | |||||||||||||
| and 5) | |||||||||||||
| Amount | |||||||||||||
| or | |||||||||||||
| Number | |||||||||||||
| Date | Expiration | of | |||||||||||
| Code | V | (A) (D) |
Exercisable | Date | Title Shares |
Explanation of Responses:
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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).
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Represents the number of shares automatically sold to satisfy the Issuer's income tax withholding and remittance obligations in connection with the vesting of restricted stock units. Remarks:
/s/ Susan Szotek, Attorney-in-Fact 01/05/2023 ** Signature of Reporting Person Date
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
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If the form is filed by more than one reporting person, see Instruction 4 (b)(v).
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** Intentional misstatements or omissions of facts constitute Federal Criminal Violations See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
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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/1512673/000120919123002000/xslF345X03/doc4.xml
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