FORM 3 |
UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 or Section 30(h) of the Investment Company Act of 1940 |
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1. Name and Address of Reporting Person*
(Street)
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2. Date of Event Requiring Statement
(Month/Day/Year) 02/16/2023 |
3. Issuer Name and Ticker or Trading Symbol
Block, Inc. [ SQ ] |
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4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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5. If Amendment, Date of Original Filed
(Month/Day/Year) |
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6. Individual or Joint/Group Filing (Check Applicable Line)
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Table I - Non-Derivative Securities Beneficially Owned | |||
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1. Title of Security (Instr. 4) | 2. Amount of Securities Beneficially Owned (Instr. 4) | 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) | 4. Nature of Indirect Beneficial Ownership (Instr. 5) |
Class A Common Stock | 42,154(1)(2)(3)(4)(5) | D |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||
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1. Title of Derivative Security (Instr. 4) | 2. Date Exercisable and Expiration Date (Month/Day/Year) | 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) | 4. Conversion or Exercise Price of Derivative Security | 5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) | 6. Nature of Indirect Beneficial Ownership (Instr. 5) | ||
Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||
Stock Option (Right to Buy) | (6) | 10/30/2023 | Class B Common Stock(7) | 3,150 | $3.663 | D | |
Stock Option (Right to Buy) | (6) | 06/16/2025 | Class B Common Stock(7) | 20,000 | $13.94 | D | |
Stock Option (Right to Buy) | (6) | 06/16/2025 | Class B Common Stock(7) | 14,415 | $13.94 | D | |
Stock Option (Right to Buy) | (8) | 04/23/2029 | Class A Common Stock | 5,513 | $71.99 | D |
Explanation of Responses: |
1. Represents 24,107 shares of the Issuer's Class A Common Stock owned and 18,047 shares represented by unvested Restricted Stock Units (RSUs). |
2. 207 of the RSUs represent a contingent right to receive one share of the Issuer's Class A Common Stock upon settlement. Of the original grant of an aggregate of 3,308 RSUs, 1/16 of the RSUs vested on July 1, 2019 and 1/16 of the total RSUs vest every three months thereafter. |
3. 5,650 of the RSUs represent a contingent right to receive one share of the Issuer's Class A Common Stock upon settlement. Of the original grant of an aggregate of 15,066 RSUs, 1/16 of the RSUs vested on July 1, 2020 and 1/16 of the total RSUs vest every three months thereafter. |
4. 1,944 of the RSUs represent a contingent right to receive one share of the Issuer's Class A Common Stock upon settlement. Of the original grant of an aggregate of 3,455 RSUs, 1/16 of the RSUs vested on July 1, 2021 and 1/16 of the total RSUs vest every three months thereafter. |
5. 10,246 of the RSUs represent a contingent right to receive one share of the Issuer's Class A Common Stock upon settlement. Of the original grant of an aggregate of 12,610 RSUs, 1/16 of the RSUs vested on July 1, 2022 and 1/16 of the total RSUs vest every three months thereafter. |
6. All of the shares subject to this option are fully vested and exercisable as of the date hereof. |
7. Each share of Class B Common Stock is convertible into one share of Class A Common Stock a the option of the holder. |
8. This option, originally for 8,269 shares, of which 2,756 shares have been exercised, vested as to 1/48th of the shares on May 1, 2019 and 1/48 of the shares vest monthly thereafter. |
Remarks: |
/s/ Susan Szotek, Attorney-in-Fact | 02/17/2023 | |
** Signature of Reporting Person | Date | |
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | ||
* If the form is filed by more than one reporting person, see Instruction 5 (b)(v). | ||
** Intentional misstatements or omissions of facts constitute Federal Criminal Violations See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). | ||
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure. | ||
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number. |