0001820953-21-000036.txt : 20210322 0001820953-21-000036.hdr.sgml : 20210322 20210322212739 ACCESSION NUMBER: 0001820953-21-000036 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20210318 FILED AS OF DATE: 20210322 DATE AS OF CHANGE: 20210322 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Levchin Max R CENTRAL INDEX KEY: 0001539853 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-39888 FILM NUMBER: 21762890 MAIL ADDRESS: STREET 1: C/O YELP! INC. STREET 2: 706 MISSION ST. CITY: SAN FRANCISCO STATE: CA ZIP: 94103 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_161646284303302.xml FORM 4 X0306 4 2021-03-18 0 0001820953 Affirm Holdings, Inc. AFRM 0001539853 Levchin Max R C/O AFFIRM HOLDINGS, INC. 650 CALIFORNIA STREET SAN FRANCISCO CA 94108 1 1 1 0 Chief Executive Officer Class A Common Stock 2021-03-18 4 C 0 361759 0 A 361759 I By 2012 MRL Investments LLC Class A Common Stock 2021-03-18 4 J 0 361759 0 D 0 I By 2012 MRL Investments LLC Class A Common Stock 735294 I By Levchin 2012 Irrevocable Trust Class B Common Stock 2021-03-18 4 C 0 361759 0 D Class A Common Stock 361759.0 10352528 I By 2012 MRL Investments LLC Class B Common Stock Class A Common Stock 735294.0 735294 I By Levchin 2012 Irrevocable Trust Class B Common Stock Class A Common Stock 15397650.0 15397650 D The Reporting Person has sole voting and investment power over the shares held by 2012 MRL Investments LLC. Represents a pro-rata, in-kind distribution by 2012 MRL Investments LLC to its members (excluding the Reporting Person) without additional consideration. As joint settlors of the Levchin 2012 Irrevocable Trust, the Reporting Person and his spouse jointly have the right to acquire the shares held by the trust but do not have voting or investment power over such shares. 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. Each share of the Issuer's Class B common stock, par value $0.00001 per share ("Class B Common Stock"), is convertible at any time into one share of the Issuer's Class A common stock, par value $0.00001 per share. The Class B Common Stock has no expiration date. /s/ David Ritenour, Attorney-in-Fact 2021-03-22