0001628280-23-040785.txt : 20231205
0001628280-23-040785.hdr.sgml : 20231205
20231205180152
ACCESSION NUMBER: 0001628280-23-040785
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20231201
FILED AS OF DATE: 20231205
DATE AS OF CHANGE: 20231205
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Jiyane Siphelele
CENTRAL INDEX KEY: 0001832806
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-39888
FILM NUMBER: 231467874
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) 960-1518
MAIL ADDRESS:
STREET 1: 650 CALIFORNIA STREET
CITY: SAN FRANCISCO
STATE: CA
ZIP: 94108
4
1
wk-form4_1701817303.xml
FORM 4
X0508
4
2023-12-01
0
0001820953
Affirm Holdings, Inc.
AFRM
0001832806
Jiyane Siphelele
C/O AFFIRM HOLDINGS, INC.
650 CALIFORNIA STREET
SAN FRANCISCO
CA
94108
0
1
0
0
Vice President, Controller
0
Class A Common Stock
2023-12-01
4
M
0
7411
0
A
170941
D
Class A Common Stock
2023-12-01
4
F
0
2974
37.67
D
167967
D
Restricted Stock Units
2023-12-01
4
M
0
3784
0
D
2027-10-26
Class A Common Stock
3784
10092
D
Restricted Stock Units
2023-12-01
4
M
0
294
0
D
2028-07-14
Class A Common Stock
294
1670
D
Restricted Stock Units
2023-12-01
4
M
0
1666
0
D
Class A Common Stock
1666
10001
D
Restricted Stock Units
2023-12-01
4
M
0
1667
0
D
Class A Common Stock
1667
16667
D
Represents the number of shares of the Issuer's Common Stock withheld to satisfy the Reporting Person's tax obligation in connection with the settlement of shares of Common Stock underlying the Reporting Person's restricted stock units that vested on December 1, 2023.
Includes 1,811 shares of common stock purchased in exempt transactions under the issuer's employee stock purchase plan.
Each Restricted Stock Unit (RSU) represents a contingent right to receive one share of the Issuer's Class A Common Stock.
With respect to the shares of Class A Common Stock underlying the RSUs, the RSUs vested in equal monthly installments from October 1, 2020 until August 1, 2023. Beginning September 1, 2023, the RSUs vest in equal quarterly installments, subject to the Reporting Person's continued employment with the Issuer as of each vesting date. This grant has no expiration date.
With respect to the shares of Class A Common Stock underlying the RSUs, the RSUs vested in equal monthly installments from July 1, 2021 until August 1, 2023. Beginning September 1, 2023, the RSUs vest in equal quarterly installments, subject to the Reporting Person's continued employment with the Issuer as of each vesting date. This grant has no expiration date.
With respect to the shares of Class A Common Stock underlying the RSUs, the RSUs vested in equal monthly installments from September 1, 2022 until August 1, 2023. Beginning September 1, 2023, the RSUs vest in equal quarterly installments, subject to the Reporting Person's continued employment with the Issuer as of each vesting date. This grant has no expiration date.
Grant of Restricted Stock Units (RSUs) under the Issuer's Amended and Restated 2012 Stock Plan. The RSUs vest in twelve quarterly installments beginning September 1, 2023.
/s/ David Ritenour, Attorney-in-Fact
2023-12-05