SEC Form 4 · accession 0001209191-18-063527
Block, Inc. · XYZ
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Alyssa Henry
Officer — Seller Lead
Period of report
Dec 17, 2018
Accepted (ET)
Dec 19, 2018 · 5:09 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, 2018 | A | 398 | $34.561 | A | 429,153 | D | |
| Class A Common Stock | Dec 17, 2018 | C | 50,000 | $0.00 | A | 479,153 | D | |
| Class A Common StockF4 | Dec 17, 2018 | S | 13,274 | $58.52 | D | 465,879 | D | |
| Class A Common StockF5 | Dec 17, 2018 | S | 13,964 | $59.60 | D | 451,915 | D | |
| Class A Common StockF6 | Dec 17, 2018 | S | 11,040 | $60.74 | D | 440,875 | D | |
| Class A Common StockF7 | Dec 17, 2018 | S | 11,722 | $61.48 | D | 429,153 | 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)F8,F9 | $7.254 | Dec 17, 2018 | M | 50,000 | D | — | May 14, 2024 | Class B Common Stock | 50,000 | 1,800,000 | D |
| Class B Common StockF9 | — | Dec 17, 2018 | M | 50,000 | A | — | — | Class A Common Stock | 50,000 | 50,000 | D |
| Class B Common StockF9 | — | Dec 17, 2018 | C | 50,000 | D | — | — | Class A Common Stock | 50,000 | 0 | D |
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 the conversion of Class B Common Stock into Class A Common Stock held of record 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 $58.20 to $59.17 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.
- F5The reported price in Column 4 is a weighted average sale price. These shares were sold in multiple transactions at prices ranging from $59.20 to $60.16 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.
- F6The reported price in Column 4 is a weighted average sale price. These shares were sold in multiple transactions at prices ranging from $60.20 to $61.19 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.
- F7The reported price in Column 4 is a weighted average sale price. These shares were sold in multiple transactions at prices ranging from $61.20 to $61.80 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.
- F825% of the shares subject to the option vested on May 12, 2015, and 1/48 of the shares vested monthly thereafter.
- F9Each 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.