0001628280-21-019737.txt : 20211005 0001628280-21-019737.hdr.sgml : 20211005 20211005192152 ACCESSION NUMBER: 0001628280-21-019737 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20211001 FILED AS OF DATE: 20211005 DATE AS OF CHANGE: 20211005 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Adkins Katherine CENTRAL INDEX KEY: 0001870331 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-39888 FILM NUMBER: 211308300 MAIL ADDRESS: STREET 1: C/O AFFIRM HOLDINGS, INC. STREET 2: 650 CALIFORNIA STREET CITY: SAN FRANCISCO STATE: CA ZIP: 94108 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_163347609241328.xml FORM 4 X0306 4 2021-10-01 0 0001820953 Affirm Holdings, Inc. AFRM 0001870331 Adkins Katherine C/O AFFIRM HOLDINGS, INC. 650 CALIFORNIA STREET SAN FRANCISCO CA 94108 0 1 0 0 Chief Legal Officer Class A Common Stock 2021-10-01 4 M 0 2491 0 A 10393 D Class A Common Stock 2021-10-01 4 F 0 1129 117.85 D 9264 D Restricted Stock Units 2021-10-01 4 M 0 2325 0 D 2027-10-26 Class A Common Stock 2325.0 23250 D Restricted Stock Units 2021-10-01 4 M 0 166 0 D Class A Common Stock 166.0 7284 D Each Restricted Stock Unit (RSUs) represents a contingent right to receive one share of the Issuer's Class A Common Stock. Represents the number of shares of the Issuer's Common Stock withheld to satisfy the Reporting Person's tax obligation in connection with the settlement of shares of Common Stock underlying the Reporting Person's RSUs that vested on October 1, 2021. The total number of shares of Class A common stock has been adjusted to correct for a prior administrative error with respect to the number of shares of Class A common stock reported to be held by the Reporting Person. The RSUs vest in 24 equal monthly installments until August 1, 2022, subject to the Reporting Person's continuous service with the Issuer as of each vesting date. The total number of RSUs has been adjusted to correct for a prior administrative error with respect to the number of RSUs reported to be held by the Reporting Person. The RSUs vest in 48 equal monthly installments after June 1, 2021, subject to the Reporting Person's continuous service with the Issuer as of each vesting date. This grant has no expiration date. /s/ David Ritenour, Attorney-in-Fact 2021-10-05