SEC Form 4 · accession 0001209191-17-027897
Block, Inc. · XYZ
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Alyssa Henry
Officer — Seller Lead
Period of report
Apr 19, 2017
Accepted (ET)
Apr 21, 2017 · 5:22 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 | Apr 19, 2017 | A | 265,331 | $0.00 | A | 480,644 | 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)F2 | $17.20 | Apr 19, 2017 | A | 205,683 | A | — | Apr 18, 2027 | Class A Common Stock | 205,683 | 205,683 | D |
Explanation of responses
- F1Each 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.
- F21/48 of the shares subject to the option vest on May 1, 2017, and 1/48 of the shares vest monthly thereafter.