SEC Form 4 · accession 0001209191-18-049108
Block, Inc. · XYZ
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Lawrence Henry Summers
Director
Period of report
Aug 29, 2018
Accepted (ET)
Aug 31, 2018 · 5:04 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 Stock | holding | — | — | — | 14,441 | D | ||
| Class A Common StockF1 | holding | — | — | — | 27,382 | 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 StockF2,F1 | — | Aug 29, 2018 | G | 37,163 | D | — | — | Class A Common Stock | 37,163 | 163,856 | I |
| Class B Common StockF2 | — | Aug 29, 2018 | G | 37,163 | A | — | — | Class A Common Stock | 37,163 | 37,163 | D |
Explanation of responses
- F1The shares are held of record by LHS 2017 Qualified Annuity Trust - Square, for which the Reporting Person serves as trustee.
- F2Each 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.