0001209191-22-001796.txt : 20220105 0001209191-22-001796.hdr.sgml : 20220105 20220105171240 ACCESSION NUMBER: 0001209191-22-001796 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20220103 FILED AS OF DATE: 20220105 DATE AS OF CHANGE: 20220105 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Carter Shawn Corey CENTRAL INDEX KEY: 0001549211 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-37622 FILM NUMBER: 22512242 MAIL ADDRESS: STREET 1: C/O S. CARTER ENTERPRISES, LLC STREET 2: 1411 BROADWAY CITY: NEW YORK STATE: NY ZIP: 10018 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Block, Inc. CENTRAL INDEX KEY: 0001512673 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-PREPACKAGED SOFTWARE [7372] IRS NUMBER: 800429876 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 1455 MARKET STREET STREET 2: SUITE 600 CITY: SAN FRANCISCO STATE: CA ZIP: 94103 BUSINESS PHONE: 415-375-3176 MAIL ADDRESS: STREET 1: 1455 MARKET STREET STREET 2: SUITE 600 CITY: SAN FRANCISCO STATE: CA ZIP: 94103 FORMER COMPANY: FORMER CONFORMED NAME: Square, Inc. DATE OF NAME CHANGE: 20110210 4 1 doc4.xml FORM 4 SUBMISSION X0306 4 2022-01-03 0 0001512673 Block, Inc. SQ 0001549211 Carter Shawn Corey 1455 MARKET STREET SUITE 600 SAN FRANCISCO CA 94103 1 0 0 0 Class A Common Stock 2022-01-03 4 A 0 61 0.00 A 9817 D Class A Common Stock 1779 I By immediate family member Class A Common Stock 20812 I See Footnote Class A Common Stock 296 I See Footnote Each share is represented by a restricted stock unit (RSU). Each RSU represents a contingent right to receive one share of the Issuer's Class A Common Stock upon settlement. The RSUs were issued pursuant to the Issuer's Outside Director Compensation Policy, and 100% of the RSUs were vested as of the date of grant. The shares are held of record by an immediate family member of the Reporting Person. The shares are held of record by SC Panther, LLC, for which the Reporting Person serves as the sole member. The shares are held of record by SC Vessel 5, LLC, for which the Reporting Person serves as the sole member. /s/ Susan Szotek, Attorney-in-Fact 2022-01-05