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