4//SEC Filing
Dorsey Jack 4
Accession 0001209191-22-033219
CIK 0001512673other
Filed
May 31, 8:00 PM ET
Accepted
Jun 1, 5:14 PM ET
Size
10.1 KB
Accession
0001209191-22-033219
Insider Transaction Report
Form 4
Dorsey Jack
DirectorBlock Head and Chairperson10% Owner
Transactions
- Conversion
Class A Common Stock
2022-05-27+1,000,000→ 1,000,000 total(indirect: See Footnote) - Conversion
Class B Common Stock
2022-05-27−1,000,000→ 35,763,992 total(indirect: See Footnote)→ Class A Common Stock (1,000,000 underlying)
Holdings
- 12,080,574(indirect: See Footnote)
Class B Common Stock
→ Class A Common Stock (12,080,574 underlying)
Footnotes (5)
- [F1]Represents the conversion of Class B Common Stock into Class A Common Stock held of record by the Jack Dorsey Revocable Trust u/a/d 12/8/10, for which the Reporting Person serves as Trustee (the "Dorsey Revocable Trust"). This conversion was effected in connection with the contribution by the Reporting Person of 1,000,000 shares of Class A Common Stock from the Dorsey Revocable Trust to The Jack Dorsey 2022 Annuity Trust, a grantor retained annuity trust for which the Reporting Person serves as Co-Trustee (the "Dorsey Annuity Trust"), which contribution is exempt from Section 16 of the Securities Exchange Act of 1934, as amended (the "Exchange Act"), pursuant to Rule 16a-13 under the Exchange Act.
- [F2]The shares are held of record by the Dorsey Annuity Trust.
- [F3]Each 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.
- [F4]The shares are held of record by the Jack Dorsey Revocable Trust u/a/d 12/8/10, for which the Reporting Person serves as a Trustee.
- [F5]The shares are held of record by Start Small, LLC, for which the Reporting Person is the sole member.
Documents
Issuer
Block, Inc.
CIK 0001512673
Entity typeother
Related Parties
1- filerCIK 0001590945
Filing Metadata
- Form type
- 4
- Filed
- May 31, 8:00 PM ET
- Accepted
- Jun 1, 5:14 PM ET
- Size
- 10.1 KB