SEC Form 4 · accession 0001209191-15-082011
Block, Inc. · XYZ
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Sarah Friar
Officer — Chief Financial Officer · 10% Owner
Period of report
Nov 24, 2015
Accepted (ET)
Nov 24, 2015 · 4:41 pm EST
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0001512673
Table I — non-derivative securities
| Security | Date | Code | Shares | Price | A/D | Owned after | D/I | Nature of ownership |
|---|---|---|---|---|---|---|---|---|
| Common StockF1,F2 | Nov 24, 2015 | J | 1,348,769 | — | D | 0 | I | See footnote |
Table II — derivative securities
| Security | Conv. / exercise price | Date | Code | Shares | A/D | Exercisable | Expires | Underlying | Underlying shares | Owned after | D/I |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Class B Common StockF1,F3,F2 | — | Nov 24, 2015 | J | 1,348,769 | A | — | — | Class A Common Stock | 1,348,769 | 1,348,769 | I |
| Stock Option (right to buy)F4,F1 | $2.728 | Nov 24, 2015 | J | 344,246 | D | — | Jul 25, 2022 | Common Stock | 344,246 | 0 | D |
| Stock Option (right to buy)F4,F1,F3 | $2.728 | Nov 24, 2015 | J | 344,246 | A | — | Jul 25, 2022 | Class B Common Stock | 344,246 | 344,246 | D |
| Stock Option (right to buy)F5,F1 | $2.904 | Nov 24, 2015 | J | 36,250 | D | — | May 31, 2023 | Common Stock | 36,250 | 0 | D |
| Stock option (right to buy)F5,F1,F3 | $2.904 | Nov 24, 2015 | J | 36,250 | A | — | May 31, 2023 | Class B Common Stock | 36,250 | 36,250 | D |
| Stock Option (right to buy)F6,F1 | $3.334 | Nov 24, 2015 | J | 494,067 | D | — | Aug 27, 2023 | Common Stock | 494,067 | 0 | D |
| Stock Option (right to buy)F6,F1,F3 | $3.334 | Nov 24, 2015 | J | 494,067 | A | — | Aug 27, 2023 | Class B Common Stock | 494,067 | 494,067 | D |
| Stock Option (right to buy)F7,F1 | $7.254 | Nov 24, 2015 | J | 276,668 | D | — | Feb 27, 2024 | Common Stock | 276,668 | 0 | D |
| Stock Option (right to buy)F7,F1,F3 | $7.254 | Nov 24, 2015 | J | 276,668 | A | — | Feb 27, 2024 | Class B Common Stock | 276,668 | 276,668 | D |
| Stock Option (right to buy)F8,F1 | $10.06 | Nov 24, 2015 | J | 1,400,000 | D | — | Feb 24, 2025 | Common Stock | 1,400,000 | 0 | D |
| Stock Option (right to buy)F8,F1,F3 | $10.06 | Nov 24, 2015 | J | 1,400,000 | A | — | Feb 24, 2025 | Class B Common Stock | 1,400,000 | 1,400,000 | D |
Explanation of responses
- F1Immediately prior to the closing of the Issuer's initial public offering, each share of Common Stock was reclassified into one share of Class B Common Stock in an exempt transaction pursuant to Rule 16b-7.
- F2The shares are held of record by The Sarah Friar 2015 GRAT, dated August 6, 2015, for which the Reporting Person serves as a trustee.
- F3Each share of Class B Common Stock is convertible into one share of Class A Common Stock at the option of the holder and has no expiration date.
- F425% of the shares subject to the option vested on July 9, 2013, and 1/48 of the shares vest monthly thereafter. The original grant for 1,180,270 shares was early exercised for 590,130 shares on August 31, 2012, and exercised for 245,894 shares on June 4, 2015.
- F525% of the shares subject to the option vested on May 16, 2014, and 1/48 of the shares vest monthly thereafter. The original grant of 72,500 shares was exercised for 36,250 shares on June 4, 2015.
- F625% of the shares subject to the option vested on August 27, 2014, and 1/48 of the shares vest monthly thereafter. The original grant of 878,340 shares was exercised for 384,273 shares on June 4, 2015.
- F720% of the shares subject to the option vested on February 25, 2015, and 1/60 of the shares vest monthly thereafter. The original grant of 368,890 shares was exercised for 92,222 shares on June 4, 2015.
- F820% of the shares subject to the option vest on March 1, 2016, and 1/60 of the shares vest monthly thereafter.