0001628280-23-032875.txt : 20230922 0001628280-23-032875.hdr.sgml : 20230922 20230922181154 ACCESSION NUMBER: 0001628280-23-032875 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: Adkins Katherine CENTRAL INDEX KEY: 0001870331 FILING VALUES: FORM TYPE: 4/A SEC ACT: 1934 Act SEC FILE NUMBER: 001-39888 FILM NUMBER: 231272704 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_1695420704.xml FORM 4/A X0508 4/A 2023-09-13 2023-09-15 0 0001820953 Affirm Holdings, Inc. AFRM 0001870331 Adkins Katherine C/O AFFIRM HOLDINGS, INC. 650 CALIFORNIA STREET SAN FRANCISCO CA 94108 0 1 0 0 Chief Legal Officer 0 Class A Common Stock 72722 D Restricted Stock Units 2023-09-13 4 A 0 81370 0 A Class A Common Stock 81370 81370 D Stock Option (Right to Buy) 23.35 2023-09-13 4 A 0 118012 0 A 2033-09-13 Class A Common Stock 118012 118012 D Each Restricted Stock Unit represents a contingent right to receive one share of the Issuer's Class A Common Stock. The RSUs vest in 16 equal quarterly installments beginning September 1, 2024, subject to the Reporting Person's continuous service with the Issuer as of each vesting date. This grant has no expiration date. 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