0001628280-21-023989.txt : 20211122
0001628280-21-023989.hdr.sgml : 20211122
20211122171249
ACCESSION NUMBER: 0001628280-21-023989
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20211118
FILED AS OF DATE: 20211122
DATE AS OF CHANGE: 20211122
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Philips Jeremy
CENTRAL INDEX KEY: 0001536014
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-39888
FILM NUMBER: 211433521
MAIL ADDRESS:
STREET 1: C/O TRIPADVISOR, INC.
STREET 2: 141 NEEDHAM STREET
CITY: NEWTON
STATE: MA
ZIP: 02464
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: Affirm Holdings, Inc.
CENTRAL INDEX KEY: 0001820953
STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-BUSINESS SERVICES, NEC [7389]
IRS NUMBER: 842224323
STATE OF INCORPORATION: DE
FISCAL YEAR END: 0630
BUSINESS ADDRESS:
STREET 1: 650 CALIFORNIA STREET
CITY: SAN FRANCISCO
STATE: CA
ZIP: 94108
BUSINESS PHONE: (415) 722-8633
MAIL ADDRESS:
STREET 1: 650 CALIFORNIA STREET
CITY: SAN FRANCISCO
STATE: CA
ZIP: 94108
4
1
wf-form4_163761914981937.xml
FORM 4
X0306
4
2021-11-18
0
0001820953
Affirm Holdings, Inc.
AFRM
0001536014
Philips Jeremy
137 NEWBURY STREET, 8TH FLOOR
BOSTON
MA
02116
1
0
0
0
Class A Common Stock
2021-11-18
4
M
0
4082
0
A
757808
D
Class A Common Stock
757
I
See Footnote
Class A Common Stock
74243
I
See Footnote
Class A Common Stock
12572
I
See Footnote
Restricted Stock Units
2021-11-18
4
M
0
4082
0
D
2028-01-12
Class A Common Stock
4082.0
0
D
These shares are held of record by Spark Capital Growth Founders' Fund III, L.P. ("Spark Capital Growth FF III"). Spark Growth Management Partners III, LLC ("SGMP III") is the general partner of Spark Capital Growth FF III. The Reporting Person is the managing member of SGMP III, which makes all voting and investment decisions for the fund through its investment committee, of which the Reporting Person is also a member. The Reporting Person disclaims beneficial ownership of these securities except to the extent of his pecuniary interest therein, and the inclusion of these shares in this report shall not be deemed an admission of beneficial ownership of all of the reported shares for purposes of Section 16 or for any other purpose.
These shares are held of record by Spark Capital Growth Fund III, L.P. ("Spark Capital Growth III"). SGMP III is the general partner of Spark Capital Growth III. The Reporting Person is the managing member of SGMP III, which makes all voting and investment decisions for the fund through its investment committee, of which the Reporting Person is also a member. The Reporting Person disclaims beneficial ownership of these securities except to the extent of his pecuniary interest therein, and the inclusion of these shares in this report shall not be deemed an admission of beneficial ownership of all of the reported shares for purposes of Section 16 or for any other purpose.
The shares are held by Spark Capital Parters, LLC ("SCP"). The Reporting Person is a managing member of SCP and may be deemed to share investment, voting and dispositive power over these shares. The Reporting Person disclaims beneficial ownership of these securities except to the extent of his pecuniary interest therein, if any, and the inclusion of these shares in this report shall not be deemed an admission of beneficial ownership of all of the reported shares for purposes of Section 16 or for any other purpose.
Each Restricted Stock Unit represents a contingent right to receive one share of the Issuer's Class A Common Stock.
The number of RSUs owned has been increased by one due to a rounding error on the Reporting Person's Form 3 filed on January 13, 2021.
Restricted stock units vest in full upon the earlier of November 18, 2021 or the date of the Issuer's next annual meeting of stockholders, subject to continued service by the Reporting Person as a non-employee director until such earlier date.
/s/ David Ritenour, Attorney-in-Fact
2021-11-22