Form 4 for XYZ Block, Inc.
Accepted 2022-06-01 00:00:00 ET · period of report 2022-05-27 · accession 0001209191-22-033219 · SEC index · Original document
Summary rows
Aggregated the way they appear in lists: one row per insider, transaction code and security table.
| X | Filed | Traded | Ticker | Insider | Title | Type | Price | Qty | Owned | ΔOwn | Value |
|---|---|---|---|---|---|---|---|---|---|---|---|
| DI | 2022-06-01 | 2022-05-27 | XYZ | Dorsey Jack | COB, Block Head, Dir, 10% | C - Cnv Deriv | $0.00 | +1.00M | 1.00M | New | $0 |
| DI | 2022-06-01 | 2022-05-27 | XYZ | Dorsey Jack | COB, Block Head, Dir, 10% | C - Cnv Deriv | $0.00 | -1.00M | 35.76M | -3% | $0 |
Purchase Sale Sale after option exercise All abbreviations
Every reported transaction
| # | Table | Security | Date | Code | A/D | Shares | Price | Owned after | Own | Exercise / expiry | Underlying | Footnotes |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1 | Common | Class A Common Stock | 2022-05-27 | C | A | 1,000,000 | $0.00 | 1,000,000 | I See Footnote | — | — | (F2) The shares are held of record by the Dorsey Annuity Trust. |
| 2 | Derivative | Class B Common Stock | 2022-05-27 | C | D | 1,000,000 | $0.00 | 35,763,992 | I See Footnote | — · — to — | 1,000,000 Class A Common Stock | (F3) 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. (F4) The shares are held of record by the Jack Dorsey Revocable Trust u/a/d 12/8/10, for which the Reporting Person serves as a Trustee. |