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