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