Form4insider filings, from the source

SEC Form 4 · accession 0001104659-16-122064

Block, Inc. · XYZ

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

Reporting owners
Suhail Rizvi
10% Owner
Period of report
May 6, 2016
Accepted (ET)
May 19, 2016 · 3:10 pm EDT
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0001512673

Table I — non-derivative securities

SecurityDateCodeSharesPriceA/DOwned afterD/INature of ownership
Class A Common StockF1May 6, 2016C87,420$0.00A87,420ISee footnote
Class A Common StockF2May 6, 2016C17,560$0.00A17,560ISee footnote
Class A Common StockF3May 6, 2016C249,500$0.00A249,500ISee footnote
Class A Common StockF4May 6, 2016C59,250$0.00A59,250ISee footnote
Class A Common StockF5May 6, 2016C40,210$0.00A40,210ISee footnote

Table II — derivative securities

SecurityConv. / exercise priceDateCodeSharesA/DExercisableExpiresUnderlyingUnderlying sharesOwned afterD/I
Class B Common StockF6,F7,F1—May 6, 2016C87,420D——Class A Common Stock87,4200I
Class B Common StockF6,F7,F2—May 6, 2016C17,560D——Class A Common Stock17,5600I
Class B Common StockF6,F7,F3—May 6, 2016C249,500D——Class A Common Stock249,5000I
Class B Common StockF6,F7,F4—May 6, 2016C59,250D——Class A Common Stock59,2500I
Class B Common StockF6,F7,F5—May 6, 2016C40,210D——Class A Common Stock40,2100I

Explanation of responses

Remarks

This report is filed as one of two 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; and RT SQ Co-Invest, LLC.