SEC Form 4 · accession 0001209191-17-027783
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
Apr 18, 2017
Accepted (ET)
Apr 20, 2017 · 8:09 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 StockF2,F3 | Apr 18, 2017 | S | 19,200 | $16.96 | D | 57,600 | I | See Footnote |
| Class A Common StockF4,F3 | Apr 19, 2017 | S | 19,200 | $17.28 | D | 38,400 | I | See Footnote |
| Class A Common StockF5 | Apr 19, 2017 | A | 265,331 | $0.00 | A | 375,916 | 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)F6 | $17.20 | Apr 19, 2017 | A | 205,683 | A | — | Apr 18, 2027 | Class A Common Stock | 205,683 | 205,683 | D |
Explanation of responses
- F1The sales reported on this Form 4 were effected pursuant to a Rule 10b5-1 trading plan adopted by the 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.
- F2The reported price in Column 4 is a weighted average sale price. These shares were sold in multiple transactions at prices ranging from $16.87 to $17.04 per share. The Reporting Person undertakes to provide to the Issuer, any security holder of the Issuer, or the staff of the Securities and Exchange Commission, upon request, full information regarding the number of shares sold at each separate price within the range set forth in this footnote.
- F3The shares are held of record by the Revocable Trust.
- F4The reported price in Column 4 is a weighted average sale price. These shares were sold in multiple transactions at prices ranging from $17.06 to $17.39 per share. The Reporting Person undertakes to provide to the Issuer, any security holder of the Issuer, or the staff of the Securities and Exchange Commission, upon request, full information regarding the number of shares sold at each separate price within the range set forth in this footnote.
- F5Each share is represented by a restricted stock unit (RSU). Each RSU represents a contingent right to receive one share of the Issuer's Class A Common Stock upon settlement. 1/16 of the RSUs vest on July 1, 2017, and 1/16 of the RSUs vest every three months thereafter.
- F61/48 of the shares subject to the option vest on May 1, 2017, and 1/48 of the shares vest monthly thereafter.