Form4insider filings, from the source

SEC Form 4 · accession 0001104659-15-081149

Block, Inc. · XYZ

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

Reporting owners
Suhail Rizvi
10% Owner
RT-SQ TS, LLC
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, 2015C999,998—A999,998ISee footnote
Common StockF3,F2Nov 24, 2015J999,998—D0ISee footnote
Common StockF3,F4Nov 24, 2015J902,150—D0ISee footnote
Common StockF3,F5Nov 24, 2015J628,960—D0ISee footnote
Class A Common StockF6Nov 24, 2015P750,000$9.00A750,000ISee footnote
Class A Common StockF6Nov 24, 2015J750,000$0.00D0ISee footnote

Table II — derivative securities

SecurityConv. / exercise priceDateCodeSharesA/DExercisableExpiresUnderlyingUnderlying sharesOwned afterD/I
Series E Preferred StockF2,F1—Nov 24, 2015C485,014D——Common Stock999,9980I
Class B Common StockF3,F8,F2—Nov 24, 2015J999,998A——Class A Common Stock999,998999,998I
Class B Common StockF3,F8,F4—Nov 24, 2015J902,150A——Class A Common Stock902,150902,150I
Class B Common StockF3,F8,F5—Nov 24, 2015J628,960A——Class A Common Stock628,960628,960I

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.