SEC Form 4 · accession 0001209191-17-043644
Block, Inc. · XYZ
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Ajmere Dale
Officer — Chief Accounting Officer
Period of report
Jul 1, 2017
Accepted (ET)
Jul 5, 2017 · 6:17 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 | 1,702 | $10.23 | A | 149,391 | D | |
| Class A Common StockF2 | Jul 1, 2017 | F | 406 | $23.46 | D | 148,985 | D |
Table II — derivative securities
No Table II lines on this filing.
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).
- F2Represents shares that have been withheld by the Issuer to satisfy its income tax and withholding and remittance obligations in connection with the net settlement of restricted stock units and does not represent a sale by the Reporting Person.