0001209191-22-037549.txt : 20220616
0001209191-22-037549.hdr.sgml : 20220616
20220616174300
ACCESSION NUMBER: 0001209191-22-037549
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20220614
FILED AS OF DATE: 20220616
DATE AS OF CHANGE: 20220616
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: McKelvey James Morgan Jr.
CENTRAL INDEX KEY: 0001658460
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-37622
FILM NUMBER: 221021628
MAIL ADDRESS:
STREET 1: 2645 SOUTH BAYSHORE #802
CITY: MIAMI
STATE: FL
ZIP: 33133
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
2022-06-14
0
0001512673
Block, Inc.
SQ
0001658460
McKelvey James Morgan Jr.
1455 MARKET STREET
SUITE 600
SAN FRANCISCO
CA
94103
1
0
0
0
Class A Common Stock
2022-06-14
4
A
0
4145
0.00
A
5376
D
Class A Common Stock
125000
I
See Footnote
Class B Common Stock
Class A Common Stock
12259025
12259025
I
See Footnote
Represents an automatic annual restricted stock unit (RSU) award issued pursuant to the Issuer's Outside Director Compensation Policy. Each RSU represents a contingent right to receive one share of Issuer's Class A Common Stock upon settlement. 100% of the RSUs vest on the earlier of June 14, 2023, or the date of the Issuer's next annual meeting of stockholders.
The shares are held by the Anna Elefteria Ntenta Trust, dated 11/30/2017, for the benefit of the Reporting Person's spouse.
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.
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.
/s/ Susan Szotek, Attorney-in-Fact
2022-06-16