James Morgan McKelvey Jr. - 10 Dec 2021 Form 4 Insider Report for Block, Inc. (XYZ)

Role
Director
Signature
/s/ Susan Szotek, Attorney-in-Fact
Issuer symbol
XYZ
Transactions as of
10 Dec 2021
Net transactions value
$0
Form type
4
Filing time
14 Dec 2021, 16:42:03 UTC
Previous filing
05 Oct 2021
Next filing
05 Jan 2022
SEC
View on sec.gov

Transactions Table

Type Sym Class Transaction Value $ Shares Change % * Price $ Shares After Date Ownership Footnotes
transaction SQ Class A Common Stock Gift $0 -50,000 -29% $0.000000 125,000 10 Dec 2021 See Footnote F1, F2
transaction SQ Class A Common Stock Gift $0 +50,000 +1280% $0.000000 53,906 10 Dec 2021 Direct F1
transaction SQ Class A Common Stock Conversion of derivative security $0 +372,191 +690% $0.000000 426,097 10 Dec 2021 Direct F3
transaction SQ Class A Common Stock Gift $0 -425,000 -100% $0.000000 1,097 10 Dec 2021 Direct

Derivative Securities (e.g., puts, calls, warrants, options, convertible securities)

Type Sym Class Transaction Value $ Shares Change % * Price $ Shares After Date Underlying Class Amount Exercise Price Ownership Footnotes
transaction SQ Class B Common Stock Gift $0 -372,191 -2.9% $0.000000 12,259,025 10 Dec 2021 Class A Common Stock 372,191 See Footnote F4, F5
transaction SQ Class B Common Stock Gift $0 +372,191 $0.000000 372,191 10 Dec 2021 Class A Common Stock 372,191 Direct F4
transaction SQ Class B Common Stock Conversion of derivative security $0 -372,191 -100% $0.000000* 0 10 Dec 2021 Class A Common Stock 372,191 Direct F3, F4
* An asterisk sign (*) next to the price indicates that the price is likely invalid.

Explanation of Responses:

Id Content
F1 This transaction involved a gift of shares by a trust for the benefit of the Reporting Person's spouse to the Reporting Person.
F2 The shares are held by the Anna Elefteria Ntenta Trust, dated 11/30/2017, for the benefit of the Reporting Person's spouse.
F3 Represents the conversion of Class B Common Stock into Class A Common Stock held of record by the Reporting Person.
F4 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.
F5 The shares are held of record by the James McKelvey, Jr. Revocable Trust dated July 2, 2014, for which the Reporting Person serves as a Trustee.