Form4insider filings, from the source

SEC Form 4 · accession 0001104659-16-122066

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 · 3:11 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, 2016C565,210$0.00A565,210ISee footnote
Class A Common StockF2May 6, 2016C29,470$0.00A29,470ISee footnote
Class A Common StockF3May 6, 2016C11,349,190$0.00A11,349,190ISee footnote
Class A Common StockF4May 6, 2016C1,221,170$0.00A1,221,170ISee footnote
Class A Common StockF3May 17, 2016J11,349,190$0.00D0ISee footnote
Class A Common StockF4May 19, 2016J1,221,170$0.00D0ISee footnote

Table II — derivative securities

SecurityConv. / exercise priceDateCodeSharesA/DExercisableExpiresUnderlyingUnderlying sharesOwned afterD/I
Class B Common StockF7,F8,F1—May 6, 2016C565,210D——Class A Common Stock565,2100I
Class B Common StockF7,F8,F2—May 6, 2016C29,470D——Class A Common Stock29,4700I
Class B Common StockF7,F8,F3—May 6, 2016C11,349,190D——Class A Common Stock11,349,1900I
Class B Common StockF7,F8,F4—May 6, 2016C1,221,170D——Class A Common Stock1,221,1700I

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.