Item 1.
Block, Inc.
|
(b) |
Address of Issuers Principal Executive Offices: |
1955 Broadway, Suite 600
Oakland, CA 94612
We have
adopted a distributed work model and, therefore, have no formal headquarters. This address represents our principal executive office, which we are required to identify under Securities and Exchange Commission rules.
Item 2.
|
(a) |
Name of Person Filing: |
Jack Dorsey
|
(b) |
Address of Principal Business Office or, if none, Residence: |
c/o Block, Inc.
1955 Broadway,
Suite 600
Oakland, CA 94612
Jack Dorsey is a U.S. citizen
|
(d) |
Title of Class of Securities: |
Class A Common Stock, $0.0000001 par value per share
852234103
Item 3. |
If this statement is filed pursuant to §§ 240.13d-1(b) or 240.13d-2(b) or 240.13d-2(c), check whether the person filing is a: |
Not applicable.
|
(a) |
Amount beneficially owned: |
As of December 31, 2023, (i) 704,383 shares of Class A common stock held of record by The Jack Dorsey 2023 Annuity Trust U/A/D
May 26, 2023, (ii) 295,617 shares of Class A common stock held of record by The Jack Dorsey 2022 Annuity Trust U/A/D May 27, 2022, (iii) 35,763,992 shares of Class B common stock held of record by the Jack Dorsey Revocable Trust
U/A/D 12/8/10, for which Mr. Dorsey serves as Trustee, and (iv) 12,080,574 shares of Class B common stock held of record by Start Small, LLC, of which Mr. Dorsey is the sole member.
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. Each share of Class B Common Stock is entitled to ten votes per share, whereas each share of Class A Common Stock is entitled to one vote per share. The rights of the holders of Class A Common Stock and Class B
Common Stock are identical, except with respect to the aforementioned conversion rights and voting rights.
8.1%
The ownership percentage
above is calculated based on 555,498,864 shares of Class A Common Stock outstanding as of December 31, 2023, as reported by the Issuer to the Reporting Person, which includes 295,617 shares of Class A Common Stock held of record by
The Jack Dorsey 2022 Annuity Trust and 704,383 shares of Class A Common Stock held of record by The Jack Dorsey 2023 Annuity Trust, plus the assumed conversion of 47,844,566 shares of Class B Common Stock deemed beneficially owned by
Mr. Dorsey, as described herein, into shares of Class A Common Stock.