SEC Form 4 · accession 0001209191-16-147339
Block, Inc. · XYZ
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Sarah Friar
Officer — Chief Financial Officer
Period of report
Oct 26, 2016
Accepted (ET)
Oct 28, 2016 · 5:21 pm EDT
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 |
|---|---|---|---|---|---|---|---|---|
| Class A Common StockF1 | Oct 26, 2016 | S | 2,704 | $11.05 | D | 111,698 | D |
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 StockF2,F3 | — | Aug 9, 2016 | G | 523,135 | D | — | — | Class A Common Stock | 523,135 | 825,634 | I |
| Class B Common StockF2,F4 | — | Aug 9, 2016 | G | 523,135 | A | — | — | Class A Common Stock | 523,135 | 523,135 | I |
Explanation of responses
- F1Represents the number of shares automatically sold upon vesting of restricted stock units to cover tax withholding obligations.
- F2Each 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.
- F3The shares are held of record by The Sarah Friar 2015 GRAT, dated August 6, 2015, for which the Reporting Person serves as a trustee.
- F4The shares are held of record by David Riley and Sarah Friar Revocable Trust dated August 11, 2006 (Revocable Trust), for which the Reporting Person serves as a trustee. The Reporting Person has sole dispositive power and voting control over the shares of the Issuer held by the Revocable Trust.