Block (XYZ) Form 3 Block / Sharon Rothstein ownership change

SEC Form 3

FORM 3

UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES

Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934
or Section 30(h) of the Investment Company Act of 1940

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1. Name and Address of Reporting Person^*

Rothstein Sharon

(Last) (First) (Middle)

1455 MARKET STREET

SUITE 600

(Street)

SAN FRANCISCO CA 94103

(City) (State) (Zip)

2. Date of Event Requiring Statement (Month/Day/Year)
01/31/2022

3. Issuer Name and Ticker or Trading Symbol
Block, Inc. [ SQ ]

4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)

X	Director	10% Owner
	Officer (give title below)	Other (specify below)

5. If Amendment, Date of Original Filed (Month/Day/Year)

6. Individual or Joint/Group Filing (Check Applicable Line)

X	Form filed by One Reporting Person
	Form filed by More than One Reporting Person

Table I - Non-Derivative Securities Beneficially Owned
1. Title of Security (Instr. 4)	2. Amount of Securities Beneficially Owned (Instr. 4)	3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5)	4. Nature of Indirect Beneficial Ownership (Instr. 5)
Class A Common Stock	1,256(1)	D

Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 4)	2. Date Exercisable and Expiration Date (Month/Day/Year)		3. Title and Amount of Securities Underlying Derivative Security (Instr. 4)		4. Conversion or Exercise Price of Derivative Security	5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5)	6. Nature of Indirect Beneficial Ownership (Instr. 5)
	Date Exercisable	Expiration Date	Title	Amount or Number of Shares

Explanation of Responses:

1. Represents ownership of CHESS Depositary Interests ("CDIs"), each representing an ownership interest in a share of Class A common stock of Block, Inc. ("Block"). As of January 31, 2022 (Pacific Standard Time), the Reporting Person held 3,350 American Depositary Shares, each representing one ordinary share of Afterpay Limited ("Afterpay"). On January 31, 2022 (Pacific Standard Time), each ordinary share of Afterpay was converted into the right to receive 0.375 shares of Block Class A common stock (or CDIs) as a result of Block's indirect acquisition of Afterpay in accordance with the Scheme Implementation Deed between Block, Lanai (AU) 2 Pty Ltd, and Afterpay, dated August 2, 2021 (Australian Eastern Standard Time), as amended December 7, 2021 (Australian Eastern Daylight Time).

Remarks:

	/s/ Susan Szotek, Attorney-in-Fact	02/02/2022
	** Signature of Reporting Person	Date
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
* If the form is filed by more than one reporting person, see Instruction 5 (b)(v).
** Intentional misstatements or omissions of facts constitute Federal Criminal Violations See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure.
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