0000899243-21-044838.txt : 20211116
0000899243-21-044838.hdr.sgml : 20211116
20211116164946
ACCESSION NUMBER: 0000899243-21-044838
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20211112
FILED AS OF DATE: 20211116
DATE AS OF CHANGE: 20211116
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: 211416824
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
doc4.xml
FORM 4 SUBMISSION
X0306
4
2021-11-12
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
2021-11-12
4
J
0
2035521
0.00
D
0
I
See Footnote
Class A Common Stock
2021-11-12
4
J
0
762389
0.00
A
762389
D
Class A Common Stock
2021-11-12
4
J
0
12572
0.00
A
12572
I
See Footnote
Class A Common Stock
2021-11-12
4
J
0
9687
0.00
D
0
I
See Footnote
Class A Common Stock
2021-11-12
4
J
0
2305
0.00
A
764694
D
Class A Common Stock
2021-11-15
4
S
0
10868
150.00
D
753826
D
Class A Common Stock
2021-11-15
4
S
0
100
150.01
D
753726
D
Class A Common Stock
74243
I
See Footnote
Class A Common Stock
757
I
See Footnote
Represents a pro-rata distribution, and not a purchase or sale, without additional consideration by Spark Growth Management Partners, LLC ("SGMP") to its members.
These shares are held of record by SGMP. The Reporting Person is a managing member of SGMP 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, 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.
Represents a pro-rata distribution, and not a purchase or sale, without additional consideration by Spark Growth Management Partners III, LLC ("SGMP III") to its members.
These shares are held of record by SGMP III. The Reporting Person is a managing member of SGMP III 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, 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.
Represents a change in the form of ownership of the Reporting Person by virtue of receipt of shares as a result of the pro-rata in-kind distribution of Class A Common Stock of the Issuer for no consideration by SGMP.
Represents a change in the form of ownership of the Reporting Person by virtue of receipt of shares as a result of the pro-rata in-kind distribution of Class A Common Stock of the Issuer for no consideration by SGMP III.
These shares are held of record by Spark Capital Growth Fund III, L.P. ("Spark Growth III"). SGMP III is the general partner of Spark Growth III. The Reporting Person is a managing member of SGMP III 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, 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 Founders' Fund III, L.P. ("Spark Growth FF III"). SGMP III is the general partner of Spark Growth FF III. The Reporting Person is a managing member of SGMP III 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, 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.
Represents a change in the form of ownership of Spark Capital Partners, LLC ("SCP") by virtue of the receipt of shares in the pro-rata in-kind distribution of Class A Common Stock of the Issuer for no consideration by SGMP.
The shares are held by 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.
/s/ Jeremy Philips
2021-11-16