SEC Form 4 · accession 0001209191-15-082029
Block, Inc. · XYZ
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
David A Viniar
Director
Period of report
Nov 24, 2015
Accepted (ET)
Nov 24, 2015 · 4:50 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 | 35,000 | — | D | 0 | D | |
| Class A Common StockF1,F3 | Nov 24, 2015 | J | 35,000 | — | A | 35,000 | D |
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)F4,F1 | $3.663 | Nov 24, 2015 | J | 326,950 | D | — | Oct 30, 2023 | Common Stock | 326,950 | 0 | D |
| Stock Option (right to buy)F4,F1,F5 | $3.663 | Nov 24, 2015 | J | 326,950 | A | — | Oct 30, 2023 | Class B Common Stock | 326,950 | 326,950 | 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.
- F2Each share is represented by a restricted stock unit (RSU). Each RSU represents a contingent right to receive one share of the Issuer's Common Stock upon settlement. 25% of the RSUs vest on the date of the next annual meeting of the Issuer's stockholders, and 25% of the RSUs vest annually thereafter on the earlier of the date of the following annual meeting of the Issuer's stockholders or the anniversary of the prior annual meeting of the Issuer's stockholders.
- F3Each share is represented by a restricted stock unit (RSU). Each RSU represents a contingent right to receive one share of the Issuer's Class B Common Stock upon settlement. Each 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. 25% of the RSUs vest on the date of the next annual meeting of the Issuer's stockholders, and 25% of the RSUs vest annually thereafter on the earlier of the date of the following annual meeting of the Issuer's stockholders or the anniversary of the prior annual meeting of the Issuer's stockholders.
- F425% of the shares subject to the option vested on October 30, 2014, and 1/48 of the shares vest monthly thereafter.
- F5Each 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.