11/22/2024 | Press release | Distributed by Public on 11/22/2024 17:02
FORM 4
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 or Section 30(h) of the Investment Company Act of 1940 |
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | |
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB control number. | SEC 1474 (9-02) |
1. Title of Derivative Security (Instr. 3) |
2. Conversion or Exercise Price of Derivative Security | 3. Transaction Date (Month/Day/Year) | 3A. Deemed Execution Date, if any (Month/Day/Year) |
4. Transaction Code (Instr. 8) |
5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4, and 5) |
6. Date Exercisable and Expiration Date (Month/Day/Year) |
7. Title and Amount of Underlying Securities (Instr. 3 and 4) |
8. Price of Derivative Security (Instr. 5) |
9. Number of Derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) |
10. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 4) |
11. Nature of Indirect Beneficial Ownership (Instr. 4) |
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Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||||||
Stock Option (Right to Buy) | $2.04 | 11/20/2024 | M | 77,105(1) | (5) | 11/16/2027 | Class A Common Stock | 77,105 | $ 0 | 11,847 | D | ||||
Stock Option (Right to Buy) | $2.04 | 11/21/2024 | M | 11,847(1) | (5) | 11/16/2027 | Class A Common Stock | 11,847 | $ 0 | 0 | D | ||||
Stock Option (Right to Buy) | $8.8 | 11/21/2024 | M | 100,000(1) | (6) | 12/16/2029 | Class A Common Stock | 100,000 | $ 0 | 500,000 | D |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
Michalek Libor C/O AFFIRM HOLDINGS, INC. 650 CALIFORNIA STREET SAN FRANCISCO, CA 94108 |
X | President |
/s/ Josh Samples, Attorney-in-Fact | 11/22/2024 |
**Signature of Reporting Person | Date |
* | If the form is filed by more than one reporting person, see Instruction 4(b)(v). |
** | Intentional misstatements or omissions of facts constitute Federal Criminal Violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). |
(1) | The transactions reported in this Form 4 were effected pursuant to a Rule 10b5-1 trading plan adopted by the reporting person on December 13, 2023. |
(2) | Represents the weighted average sale price of the shares sold from $64.00 to $64.31 per share. The Reporting Person will provide, upon request by the Commission staff, the Issuer, or a security holder of the Issuer, full information regarding the number of shares sold at each separate price within the range set forth in this footnote. |
(3) | Represents the weighted average sale price of the shares sold from $66.00 to $66.19 per share. The Reporting Person will provide, upon request by the Commission staff, the Issuer, or a security holder of the Issuer, full information regarding the number of shares sold at each separate price within the range set forth in this footnote. |
(4) | 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. |
(5) | The stock option vested monthly at the rate of 1/48 of the shares of Class A Common Stock underlying the stock option following October 9, 2017, the vesting commencement date, subject to continued service with the Issuer. |
(6) | The stock options vest monthly at the rate of 1/48 of the shares of Class A Common Stock underlying the stock option following December 4, 2019, the vesting commencement date, subject to continued service with the Issuer. |