SEC Form 4 · accession 0001209191-17-063830
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
Dec 1, 2017
Accepted (ET)
Dec 5, 2017 · 3:33 pm EST
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 | Nov 15, 2017 | A | 2,127 | $10.23 | A | 118,196 | D | |
| Class A Common StockF2 | Dec 1, 2017 | F | 3,860 | $38.22 | D | 114,336 | D | |
| Class A Common StockF4 | Dec 4, 2017 | S | 2,814 | $37.23 | D | 111,522 | 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.
- F3The sales reported on this Form 4 were effected pursuant to a Rule 10b5-1 trading plan.
- F4The reported price in Column 4 is a weighted average sale price. These shares were sold in multiple transactions at prices ranging from $36.82 to $37.47 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.