0001209191-21-003457.txt : 20210113
0001209191-21-003457.hdr.sgml : 20210113
20210113181657
ACCESSION NUMBER: 0001209191-21-003457
CONFORMED SUBMISSION TYPE: 3
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20210113
FILED AS OF DATE: 20210113
DATE AS OF CHANGE: 20210113
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Founders Fund V Management, LLC
CENTRAL INDEX KEY: 0001697733
FILING VALUES:
FORM TYPE: 3
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-39888
FILM NUMBER: 21527044
BUSINESS ADDRESS:
STREET 1: ONE LETTERMAN DRIVE
STREET 2: BUILDING D, 5TH FLOOR
CITY: SAN FRANCISCO
STATE: CA
ZIP: 94129
BUSINESS PHONE: 4152305800
MAIL ADDRESS:
STREET 1: ONE LETTERMAN DRIVE
STREET 2: BUILDING D, 5TH FLOOR
CITY: SAN FRANCISCO
STATE: CA
ZIP: 94129
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Founders Fund V Entrepreneurs Fund, LP
CENTRAL INDEX KEY: 0001813981
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
FILING VALUES:
FORM TYPE: 3
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-39888
FILM NUMBER: 21527045
BUSINESS ADDRESS:
STREET 1: ONE LETTERMAN DRIVE
STREET 2: BUILDING D, SUITE 500
CITY: SAN FRANCISCO
STATE: CA
ZIP: 94129
BUSINESS PHONE: (415) 230-5800
MAIL ADDRESS:
STREET 1: ONE LETTERMAN DRIVE
STREET 2: BUILDING D, SUITE 500
CITY: SAN FRANCISCO
STATE: CA
ZIP: 94129
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Founders Fund V Principals Fund, LP
CENTRAL INDEX KEY: 0001601424
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
FILING VALUES:
FORM TYPE: 3
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-39888
FILM NUMBER: 21527046
BUSINESS ADDRESS:
STREET 1: ONE LETTERMAN DRIVE BUILDING D SUITE 500
CITY: SAN FRANCISCO
STATE: CA
ZIP: 94129
BUSINESS PHONE: 415-230-5800
MAIL ADDRESS:
STREET 1: ONE LETTERMAN DRIVE BUILDING D SUITE 500
CITY: SAN FRANCISCO
STATE: CA
ZIP: 94129
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Founders Fund V, LP
CENTRAL INDEX KEY: 0001601419
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
FILING VALUES:
FORM TYPE: 3
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-39888
FILM NUMBER: 21527047
BUSINESS ADDRESS:
STREET 1: ONE LETTERMAN DRIVE BUILDING D SUITE 500
CITY: SAN FRANCISCO
STATE: CA
ZIP: 94129
BUSINESS PHONE: 415-230-5800
MAIL ADDRESS:
STREET 1: ONE LETTERMAN DRIVE BUILDING D SUITE 500
CITY: SAN FRANCISCO
STATE: CA
ZIP: 94129
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: THIEL PETER
CENTRAL INDEX KEY: 0001211060
FILING VALUES:
FORM TYPE: 3
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-39888
FILM NUMBER: 21527048
BUSINESS ADDRESS:
STREET 1: 9200 SUNSET BOULEVARD
STREET 2: SUITE 1110
CITY: WEST HOLLYWOOD
STATE: CA
ZIP: 90069
BUSINESS PHONE: 323-990-2000
MAIL ADDRESS:
STREET 1: 9200 SUNSET BOULEVARD
STREET 2: SUITE 1110
CITY: WEST HOLLYWOOD
STATE: CA
ZIP: 90069
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Singerman Brian Aaron
CENTRAL INDEX KEY: 0001835462
FILING VALUES:
FORM TYPE: 3
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-39888
FILM NUMBER: 21527049
MAIL ADDRESS:
STREET 1: ONE LETTERMAN DRIVE
STREET 2: BUILDING D, 5TH FLOOR
CITY: SAN FRANCISCO
STATE: CA
ZIP: 94129
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
3
1
doc3.xml
FORM 3 SUBMISSION
X0206
3
2021-01-13
0
0001820953
Affirm Holdings, Inc.
AFRM
0001697733
Founders Fund V Management, LLC
ONE LETTERMAN DRIVE, BUILDING D
5TH FLOOR
SAN FRANCISCO
CA
94129
0
0
1
0
0001813981
Founders Fund V Entrepreneurs Fund, LP
ONE LETTERMAN DRIVE, BUILDING D
5TH FLOOR
SAN FRANCISCO
CA
94129
0
0
1
0
0001601424
Founders Fund V Principals Fund, LP
ONE LETTERMAN DRIVE, BUILDING D
5TH FLOOR
SAN FRANCISCO
CA
94129
0
0
1
0
0001601419
Founders Fund V, LP
ONE LETTERMAN DRIVE, BUILDING D
5TH FLOOR
SAN FRANCISCO
CA
94129
0
0
1
0
0001211060
THIEL PETER
C/O THE FOUNDERS FUND
ONE LETTERMAN DRIVE, BUILDING D, 5TH FLO
SAN FRANCISCO
CA
94129
0
0
1
0
0001835462
Singerman Brian Aaron
C/O THE FOUNDERS FUND
ONE LETTERMAN DRIVE, BUILDING D, 5TH FLO
SAN FRANCISCO
CA
94129
0
0
1
0
Class A Common Stock
3994807
I
By Fund
Class A Common Stock
1074604
I
By Fund
Class A Common Stock
56539
I
By Fund
Class A Common Stock
2205293
I
By Fund
Class A Common Stock
545294
I
By Fund
Class A Common Stock
27418
I
By Fund
Class A Common Stock
936909
I
By Fund
Class A Common Stock
60429
I
By Fund
Class A Common Stock
142857
I
By LLC
Class B Common Stock
Class A Common Stock
3994807
I
By Fund
Class B Common Stock
Class A Common Stock
1074604
I
By Fund
Class B Common Stock
Class A Common Stock
56539
I
By Fund
Class B Common Stock
Class A Common Stock
2205293
I
By Fund
Class B Common Stock
Class A Common Stock
545294
I
By Fund
Class B Common Stock
Class A Common Stock
27418
I
By Fund
Class B Common Stock
Class A Common Stock
936909
I
By Fund
Class B Common Stock
Class A Common Stock
60429
I
By Fund
Class B Common Stock
Class A Common Stock
142857
I
By LLC
Shares held by The Founders Fund V, LP ("FF-V"). The Founders Fund V Management, LLC ("FF-VM") is the general partner of FF-V and may be deemed to beneficially own the shares held by FF-V. Peter Thiel and Brian Singerman have shared voting and investment power over the shares held by FF-V and, accordingly, may be deemed to beneficially own the shares held by FF-V. Each of FF-VM, Mr. Thiel and Mr. Singerman disclaims beneficial ownership in these shares except to the extent of his or its respective pecuniary interest therein.
Shares held by The Founders Fund V Principals Fund, LP ("FF-VP"). FF-VM is the general partner of FF-VP and may be deemed to beneficially own the shares held by FF-VP. Peter Thiel and Brian Singerman have shared voting and investment power over the shares held by FF-VP and, accordingly, may be deemed to beneficially own the shares held by FF-VP. Each of FF-VM, Mr. Thiel and Mr. Singerman disclaims beneficial ownership in these shares except to the extent of his or its respective pecuniary interest therein.
Shares held by The Founders Fund V Entrepreneurs Fund, LP ("FF-VE"). FF-VM is the general partner of FF-VE and may be deemed to beneficially own the shares held by FF-VE. Peter Thiel and Brian Singerman have shared voting and investment power over the shares held by FF-VE and, accordingly, may be deemed to beneficially own the shares held by FF-VE. Each of FF-VM, Mr. Thiel and Mr. Singerman disclaims beneficial ownership in these shares except to the extent of his or its respective pecuniary interest therein.
Shares held by The Founders Fund VI, LP ("FF-VI"). Peter Thiel, Brian Singerman and Keith Rabois have shared voting and investment power over the shares held by FF-VI and, accordingly, may be deemed to beneficially own the shares held by FF-VI. Each of Mr. Thiel and Mr. Singerman disclaims beneficial ownership in these shares except to the extent of his respective pecuniary interest therein. Mr. Rabois is a director of the Issuer and files separate Section 16 reports.
Shares held by The Founders Fund VI Principals Fund, LP ("FF-VIP"). Peter Thiel, Brian Singerman and Keith Rabois have shared voting and investment power over the shares held by FF-VIP and, accordingly, may be deemed to beneficially own the shares held by FF-VIP. Each of Mr. Thiel and Mr. Singerman disclaims beneficial ownership in these shares except to the extent of his respective pecuniary interest therein. Mr. Rabois is a director of the Issuer and files separate Section 16 reports.
Shares held by The Founders Fund VI Entrepreneurs Fund, LP ("FF-VIE"). Peter Thiel, Brian Singerman and Keith Rabois have shared voting and investment power over the shares held by FF-VIE and, accordingly, may be deemed to beneficially own the shares held by FF-VIE. Each of Mr. Thiel and Mr. Singerman disclaims beneficial ownership in these shares except to the extent of his respective pecuniary interest therein. Mr. Rabois is a director of the Issuer and files separate Section 16 reports.
Shares held by The Founders Fund Growth, LP ("FF-G"). Peter Thiel, Brian Singerman and Keith Rabois have shared voting and investment power over the shares held by FF-G and, accordingly, may be deemed to beneficially own the shares held by FF-G. Each of Mr. Thiel and Mr. Singerman disclaims beneficial ownership in these shares except to the extent of his respective pecuniary interest therein. Mr. Rabois is a director of the Issuer and files separate Section 16 reports.
Shares held by The Founders Fund Growth Principals Fund, LP ("FF-GP"). Peter Thiel, Brian Singerman and Keith Rabois have shared voting and investment power over the shares held by FF-GP and, accordingly, may be deemed to beneficially own the shares held by FF-GP. Each of Mr. Thiel and Mr. Singerman disclaims beneficial ownership in these shares except to the extent of his respective pecuniary interest therein. Mr. Rabois is a director of the Issuer and files separate Section 16 reports.
Shares held by Rivendell Investments 3 LLC. Peter Thiel is the beneficial owner of Rivendell Investments 3 LLC and has sole voting and investment power over the shares held by Rivendell Investments 3 LLC.
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 ("Class A Common Stock"). The Class B Common Stock has no expiration date.
The Reporting Persons disclaim group status and neither the fact of this filing nor anything contained herein shall be deemed to be an admission by the Reporting Persons that they have formed a group.
The Founders Fund Management V LLC, By /s/ Brian Singerman, Managing Member
2021-01-13
The Founders Fund V Entrepreneurs Fund, LP, By The Founders Fund Management V LLC, General Partner, By /s/ Brian Singerman, Managing Member
2021-01-13
The Founders Fund V Principals Fund, LP, By The Founders Fund Management V LLC, General Partner, By /s/ Brian Singerman, Managing Member
2021-01-13
The Founders Fund V, LP, By The Founders Fund Management V LLC, General Partner, By /s/ Brian Singerman, Managing Member
2021-01-13
/s/ Peter Thiel
2021-01-13
/s/ Brian A. Singerman
2021-01-13