SEC FORM
3
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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| OMB APPROVAL |
| OMB Number: |
3235-0104 |
| Estimated average burden |
| hours per response: |
0.5 |
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1. Name and Address of Reporting Person*
| C/O H&R BLOCK |
| ONE H&R BLOCK WAY |
(Street)
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2. Date of Event Requiring Statement
(Month/Day/Year)
05/01/2016
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3. Issuer Name and Ticker or Trading Symbol
H&R BLOCK INC
[ HRB ]
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4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
|
Director |
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10% Owner |
| X |
Officer (give title below) |
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Other (specify below) |
| SVP & Chief Marketing Office |
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5. If Amendment, Date of Original Filed
(Month/Day/Year)
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6. Individual or Joint/Group Filing (Check Applicable Line)
| X |
Form filed by One Reporting Person |
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Form filed by More than One Reporting Person |
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| Table I - Non-Derivative Securities Beneficially Owned |
|---|
| 1. Title of Security (Instr.
4)
|
2.
Amount of Securities Beneficially Owned (Instr.
4)
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3. Ownership Form: Direct (D) or Indirect (I) (Instr.
5)
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4. Nature of Indirect Beneficial Ownership (Instr.
5)
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Common Stock
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14,390.667 |
D |
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Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
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|---|
| 1. Title of Derivative Security (Instr.
4)
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2. Date Exercisable and Expiration Date
(Month/Day/Year) |
3. Title and Amount of Securities Underlying Derivative Security (Instr.
4)
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4. Conversion or Exercise Price of Derivative Security
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5. Ownership Form: Direct (D) or Indirect (I) (Instr.
5)
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6. Nature of Indirect Beneficial Ownership (Instr.
5)
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| Date Exercisable |
Expiration Date |
Title |
Amount or Number of Shares |
| Stock Option (Right to Buy) |
|
10/01/2020 |
Common Stock |
5,855 |
12.59 |
D |
|
| Stock Option (Right to Buy) |
|
06/30/2021 |
Common Stock |
4,116 |
16.04 |
D |
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| Explanation of Responses: |
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| Remarks: |
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Scott W. Andreasen, per Power of Attorney |
05/10/2016 |
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** 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. |
| Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number. |
LIMITED POWER OF ATTORNEY
(SECTION 16 FILINGS)
Know all by these presents, that the undersigned, Kathryn M. Collins, hereby
constitutes and appoints each of Scott W. Andreasen, Katharine M. Haynes and
Thomas A. Gerke, signing singly, the undersigned's true and lawful
attorney-in-fact to prepare, execute and acknowledge Forms 3, 4 and 5 (including
any amendments thereto and other actions or filings necessary for or related
to such forms) with respect to the securities of H&R Block, Inc., a Missouri
corporation (the "Company") and to deliver and file such forms with the United
States Securities and Exchange Commission, any national securities exchange, and
the Company, as considered necessary or advisable under Section 16(a) of the
Securities Exchange Act of 1934 and the rules and regulations promulgated
thereunder, as amended from time to time; it being understood that the documents
executed by such attorney-in-fact on behalf of the undersigned pursuant to
this Power of Attorney shall be in such form and shall contain such terms and
conditions as such attorney-in-fact may approve in such attorney-in-fact's
discretion.
The undersigned hereby grants to each such attorney-in-fact full power and
authority to do and perform any and every act and thing whatsoever requisite,
necessary, or proper to be done in the exercise of any rights and powers herein
granted, as fully to all intents and purposes as the undersigned might or could
do if personally present, with full power of substitution or revocation, hereby
ratifying and confirming all that such attorney-in-fact shall lawfully do or
cause to be done by virtue of this Power of Attorney and the rights and powers
herein granted. The undersigned acknowledges that the foregoing
attorneys-in-fact, in serving in such capacity at the request of the
undersigned, are not assuming, nor is the Company assuming, any of the
undersigned's responsibilities to comply with Section 16 of the Securities
Exchange Act of 1934.
This Power of Attorney supersedes and replaces all previously executed Powers
of Attorney with respect to the matters contained herein. This Power of Attorney
shall remain in full force and effect until the undersigned is no longer
required to file Forms 3, 4 and 5 with respect to the undersigned's holdings of
and transactions in securities issued by the Company, unless earlier revoked by
the undersigned in a signed writing delivered to the Secretary of the Company.
IN WITNESS WHEREOF, the undersigned has caused this Power of Attorney to be
executed this 29th day of April, 2016.
/s/ Kathryn M. Collins
Kathryn M. Collins
State of Missouri )
County of Jackson )
On the date set forth above, before me appeared Kathryn M. Collins, who is
personally known to me as the person who executed the foregoing instrument, and
such person duly acknowledged that such person executed and delivered the same
for the purposes therein expressed.
Valerie J. Owings
Notary Public
My Commission Expires: January 8, 2018
