SEC Form 4 · accession 0001209191-17-036026
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
May 24, 2017
Accepted (ET)
May 26, 2017 · 6:38 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 | May 15, 2017 | A | 1,803 | $10.23 | A | 375,023 | D | |
| Class A Common StockF3,F4 | May 24, 2017 | S | 19,200 | $21.73 | D | 19,200 | I | See Footnote |
| Class A Common StockF5,F4 | May 25, 2017 | S | 19,200 | $22.44 | D | 0 | I | See Footnote |
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 StockF4,F6 | — | holding | — | — | — | — | — | Class A Common Stock | 407,935 | 407,935 | I |
| Class B Common StockF7,F6 | — | holding | — | — | — | — | — | Class A Common Stock | 825,634 | 825,634 | I |
Explanation of responses
- F1These shares were acquired under the Issuer's Employee Stock Purchase Plan in a transaction that was exempt under both Rule 16b-3(d) and Rule 16b-3(c).
- F2The 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.
- F3The reported price in Column 4 is a weighted average sale price. These shares were sold in multiple transactions at prices ranging from $21.46 to $21.96 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.
- F4The shares are held of record by the Revocable Trust.
- F5The reported price in Column 4 is a weighted average sale price. These shares were sold in multiple transactions at prices ranging from $21.95 to $22.68 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.
- F6Each 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.
- F7The shares are held of record by The Sarah Friar 2015 GRAT, dated August 6, 2015, for which the Reporting Person serves as a trustee.