SEC Form 4 · accession 0001209191-15-082023
Block, Inc. · XYZ
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Ruth J Simmons
Director
Period of report
Nov 24, 2015
Accepted (ET)
Nov 24, 2015 · 4:47 pm EST
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0001512673
Table I — non-derivative securities
No Table I lines on this filing.
Table II — derivative securities
| Security | Conv. / exercise price | Date | Code | Shares | A/D | Exercisable | Expires | Underlying | Underlying shares | Owned after | D/I |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Stock Option (right to buy)F1,F2 | $15.25 | Nov 24, 2015 | J | 38,000 | D | — | Aug 11, 2025 | Common Stock | 38,000 | 0 | D |
| Stock Option (right to buy)F1,F2,F3 | $15.25 | Nov 24, 2015 | J | 38,000 | A | — | Aug 11, 2025 | Class B Common Stock | 38,000 | 38,000 | D |
Explanation of responses
- F1100% of the shares subject to the option vest on February 4, 2016.
- F2Immediately 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.
- 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.