Form4insider filings, from the source

SEC Form 4 · accession 0001104659-15-081148

Block, Inc. · XYZ

Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗

Reporting owners
Suhail Rizvi
10% Owner
Period of report
Nov 24, 2015
Accepted (ET)
Nov 24, 2015 · 4:52 pm EST
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0001512673

Table I — non-derivative securities

SecurityDateCodeSharesPriceA/DOwned afterD/INature of ownership
Common StockF1,F2Nov 24, 2015C565,210—A565,210ISee footnote
Common StockF1,F3Nov 24, 2015C29,470—A29,470ISee footnote
Common StockF1,F4Nov 24, 2015C11,349,190—A11,349,190ISee footnote
Common StockF1,F5Nov 24, 2015C1,221,170—A1,221,170ISee footnote
Common StockF6,F2Nov 24, 2015J565,210—D0ISee footnote
Common StockF6,F3Nov 24, 2015J29,470—D0ISee footnote
Common StockF6,F4Nov 24, 2015J11,349,190—D0ISee footnote
Common StockF6,F5Nov 24, 2015J1,221,170—D0ISee footnote

Table II — derivative securities

SecurityConv. / exercise priceDateCodeSharesA/DExercisableExpiresUnderlyingUnderlying sharesOwned afterD/I
Series D Preferred StockF2,F1—Nov 24, 2015C565,210D——Common Stock565,2100I
Series D Preferred StockF3,F1—Nov 24, 2015C29,470D——Common Stock29,4700I
Series D Preferred StockF4,F1—Nov 24, 2015C11,349,190D——Common Stock11,349,1900I
Series D Preferred StockF5,F1—Nov 24, 2015C1,221,170D——Common Stock1,221,1700I
Class B Common StockF6,F7,F2—Nov 24, 2015J565,210A——Class A Common Stock565,210565,210I
Class B Common StockF6,F7,F3—Nov 24, 2015J29,470A——Class A Common Stock29,47029,470I
Class B Common StockF6,F7,F4—Nov 24, 2015J11,349,190A——Class A Common Stock11,349,19011,349,190I
Class B Common StockF6,F7,F5—Nov 24, 2015J1,221,170A——Class A Common Stock1,221,1701,221,170I

Explanation of responses

Remarks

This report is filed as one of three to report related transactions for the following filers: Rizvi Traverse Management, LLC; John Giampetroni; Suhail Rizvi; Rizvi Opportunistic Equity Fund, L.P.; Rizvi Opportunistic Equity Fund (TI), L.P.; Rizvi Opportunistic Equity Fund I-B, L.P.; Rizvi Opportunistic Equity Fund I-B (TI), L.P.; Rizvi Traverse Partners, LLC; Rizvi Traverse Management II, LLC; Rizvi Opportunistic Equity Fund II, L.P.; Rizvi Traverse Partners II, LLC; RT-SQ Management, LLC; RT Spartan IV, LLC; RT SQ Co-Invest, LLC; Rizvi Traverse CI GP, LLC; RT SQ Secondary, LLC; RT SQ Co-Invest II, LLC; RT-SQ TS, LLC; and RT SQ Special Opportunities, LLC.