0001628280-21-021554.txt : 20211103 0001628280-21-021554.hdr.sgml : 20211103 20211103180136 ACCESSION NUMBER: 0001628280-21-021554 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20211101 FILED AS OF DATE: 20211103 DATE AS OF CHANGE: 20211103 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Jiyane Siphelele CENTRAL INDEX KEY: 0001832806 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-39888 FILM NUMBER: 211376929 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_163597688046706.xml FORM 4 X0306 4 2021-11-01 0 0001820953 Affirm Holdings, Inc. AFRM 0001832806 Jiyane Siphelele C/O AFFIRM HOLDINGS, INC. 650 CALIFORNIA STREET SAN FRANCISCO CA 94108 0 1 0 0 Vice President, Controller Class A Common Stock 2021-11-01 4 M 0 3860 A 29552 D Class A Common Stock 2021-11-01 4 F 0 1684 152.66 D 27868 D Class A Common Stock 2021-11-01 4 M 0 7894 2.04 A 35762 D Class A Common Stock 2021-11-01 4 S 0 1900 151.5742 D 33862 D Class A Common Stock 2021-11-01 4 S 0 4016 152.4079 D 29846 D Class A Common Stock 2021-11-01 4 S 0 17394 153.5668 D 12452 D Class A Common Stock 2021-11-01 4 S 0 4900 154.5478 D 7552 D Class A Common Stock 2021-11-01 4 S 0 1603 155.1718 D 5949 D Class A Common Stock 2021-11-01 4 S 0 1000 156.552 D 4949 D Class A Common Stock 2021-11-01 4 S 0 1300 159.2685 D 3649 D Class A Common Stock 2021-11-01 4 S 0 300 159.8667 D 3349 D Class A Common Stock 2021-11-01 4 S 0 481 162.9308 D 2868 D Restricted Stock Units 2021-11-01 4 M 0 166 0 D 2026-08-22 Class A Common Stock 166.0 2834 D Restricted Stock Units 2021-11-01 4 M 0 1440 0 D 2027-10-26 Class A Common Stock 1440.0 12960 D Restricted Stock Units 2021-11-01 4 M 0 1260 0 D 2027-10-26 Class A Common Stock 1260.0 44148 D Restricted Stock Units 2021-11-01 4 M 0 896 0 D 2027-12-31 Class A Common Stock 896.0 12542 D Restricted Stock Units 2021-11-01 4 M 0 98 0 D 2028-07-14 Class A Common Stock 98.0 4321 D Stock Option (Right to Buy) 2.04 2021-11-01 4 M 0 7894 0 D 2027-05-29 Class A Common Stock 7894.0 4106 D Each Restricted Stock Unit (RSU) 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 restricted stock units that vested on November 1, 2021. The sales reported in this Form 4 were effected pursuant to a Rule 10b5-1 trading plan adopted by the reporting person on September 15, 2021. Represents the weighted average sale price of the shares sold from $150.97 to $151.96 per share. The Reporting Person will provide, upon request by the Commission staff, the Issuer, or a security holder of the Issuer, full information regarding the number of shares sold at each separate price within the range set forth in this footnote. Represents the weighted average sale price of the shares sold from $152.03 to $152.97 per share. The Reporting Person will provide, upon request by the Commission staff, the Issuer, or a security holder of the Issuer, full information regarding the number of shares sold at each separate price within the range set forth in this footnote. Represents the weighted average sale price of the shares sold from $153.05 to $153.99 per share. The Reporting Person will provide, upon request by the Commission staff, the Issuer, or a security holder of the Issuer, full information regarding the number of shares sold at each separate price within the range set forth in this footnote. Represents the weighted average sale price of the shares sold from $154.05 to $155.03 per share. The Reporting Person will provide, upon request by the Commission staff, the Issuer, or a security holder of the Issuer, full information regarding the number of shares sold at each separate price within the range set forth in this footnote. Represents the weighted average sale price of the shares sold from $155.05 to $155.38 per share. The Reporting Person will provide, upon request by the Commission staff, the Issuer, or a security holder of the Issuer, full information regarding the number of shares sold at each separate price within the range set forth in this footnote. Represents the weighted average sale price of the shares sold from $156.12 to $157.01 per share. The Reporting Person will provide, upon request by the Commission staff, the Issuer, or a security holder of the Issuer, full information regarding the number of shares sold at each separate price within the range set forth in this footnote. Represents the weighted average sale price of the shares sold from $158.64 to $159.56 per share. The Reporting Person will provide, upon request by the Commission staff, the Issuer, or a security holder of the Issuer, full information regarding the number of shares sold at each separate price within the range set forth in this footnote. Represents the weighted average sale price of the shares sold from $159.73 to $159.94 per share. The Reporting Person will provide, upon request by the Commission staff, the Issuer, or a security holder of the Issuer, full information regarding the number of shares sold at each separate price within the range set forth in this footnote. Represents the weighted average sale price of the shares sold from $162.91 to $162.96 per share. The Reporting Person will provide, upon request by the Commission staff, the Issuer, or a security holder of the Issuer, full information regarding the number of shares sold at each separate price within the range set forth in this footnote. Restricted stock units vest with respect to the shares of Class A Common Stock underlying the restricted stock units in equal monthly installments for a period of forty-eight months beginning on April 1, 2019, the vesting commencement date, subject to the Reporting Person's continued employment with the Issuer as of each vesting date. RSUs vest with respect to the shares of Class A Common Stock underlying the RSUs in equal monthly installments for a period of twenty-four months beginning on August 1, 2020, the vesting commencement date, subject to the Reporting Person's continued employment with the Issuer as of each vesting date. RSUs vest with respect to the shares of Class A Common Stock underlying the RSUs in equal monthly installments for a period of forty-eight months beginning on October 1, 2020, the vesting commencement date, subject to the Reporting Person's continued employment with the Issuer as of each vesting date. RSUs vest with respect to the shares of Class A Common Stock underlying the RSUs in monthly installments for a period of twenty-four months beginning on January 1, 2021, the vesting commencement date, subject to the Reporting Person's continued employment with the Issuer as of each vesting date. RSUs vest with respect to the shares of Class A Common Stock underlying the RSUs in equal monthly installments for a period of forty-eight months beginning on July 1, 2021, the vesting commencement date, subject to the Reporting Person's continued employment with the Issuer as of each vesting date. Stock option vests with respect to 1/24 of the shares of the Issuer's Class A common stock, par value $0.00001 per share ("Class A Common Stock"), underlying the stock option on the one-year anniversary of July 5, 2016, the vesting commencement date of the Reporting Person's first stock option award from the Issuer, and the remaining shares underlying the option vest in equal monthly installments thereafter, in each case subject to continued service with the Issuer. The Reporting Person can elect to exercise the stock option at any time, provided that the shares acquired upon exercise remain subject to the applicable vesting schedule. /s/ David Ritenour, Attorney-in-Fact 2021-11-03