0001628280-23-032873.txt : 20230922 0001628280-23-032873.hdr.sgml : 20230922 20230922181001 ACCESSION NUMBER: 0001628280-23-032873 CONFORMED SUBMISSION TYPE: 4/A PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20230913 FILED AS OF DATE: 20230922 DATE AS OF CHANGE: 20230922 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Michalek Libor CENTRAL INDEX KEY: 0001832810 FILING VALUES: FORM TYPE: 4/A SEC ACT: 1934 Act SEC FILE NUMBER: 001-39888 FILM NUMBER: 231272695 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: PERSONAL CREDIT INSTITUTIONS [6141] 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/A 1 wk-form4a_1695420587.xml FORM 4/A X0508 4/A 2023-09-13 2023-09-15 0 0001820953 Affirm Holdings, Inc. AFRM 0001832810 Michalek Libor C/O AFFIRM HOLDINGS, INC. 650 CALIFORNIA STREET SAN FRANCISCO CA 94108 1 1 0 0 President 0 Class A Common Stock 117468 D Class A Common Stock 873294 I Michalek 2007 Trust dated March 21, 2007 Stock Option (Right to Buy) 23.35 2023-09-13 4 A 0 459627 0 A 2033-09-13 Class A Common Stock 459627 459627 D The shares are held by the Michalek 2007 Family Trust dated March 21, 2007. The Reporting Person and his spouse are trustees of the trust. The stock options vest in 48 equal monthly installments beginning September 1, 2024, subject to the Reporting Person's continuous service with the Issuer as of each vesting date. This Form 4/A is being filed to correct the number of stock options received by the Reporting Person on September 13, 2023 and provides corrected amounts in Columns 5, 7, and 9 of Table II. /s/ David Ritenour, Attorney-in-Fact 2023-09-22