0001209191-21-065101.txt : 20211117 0001209191-21-065101.hdr.sgml : 20211117 20211117162456 ACCESSION NUMBER: 0001209191-21-065101 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20211115 FILED AS OF DATE: 20211117 DATE AS OF CHANGE: 20211117 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Modersitzki Blake G CENTRAL INDEX KEY: 0001366065 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-40998 FILM NUMBER: 211420887 MAIL ADDRESS: STREET 1: 2755 EAST COTTONWOOD PARKWAY STREET 2: SUITE 520 CITY: SALT LAKE CITY STATE: UT ZIP: 84121 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Weave Communications, Inc. CENTRAL INDEX KEY: 0001609151 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-PREPACKAGED SOFTWARE [7372] IRS NUMBER: 263302902 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 1331 W POWELL WAY CITY: LEHI STATE: UT ZIP: 84043 BUSINESS PHONE: 888-579-5668 MAIL ADDRESS: STREET 1: 1331 W POWELL WAY CITY: LEHI STATE: UT ZIP: 84043 4 1 doc4.xml FORM 4 SUBMISSION X0306 4 2021-11-15 0 0001609151 Weave Communications, Inc. WEAV 0001366065 Modersitzki Blake G 2750 E. COTTONWOOD PARK, SUITE 600 SALT LAKE CITY UT 84121 1 0 0 0 Common Stock 2021-11-15 4 C 0 3815105 A 4219889 I See footnote Common Stock 2021-11-15 4 C 0 260860 A 288538 I See footnote Common Stock 2021-11-15 4 P 0 315900 24.00 A 4535789 I See footnote Common Stock 2021-11-15 4 P 0 21600 24.00 A 310138 I See footnote Common Stock 2021-11-15 4 P 0 62500 24.00 A 699444 I See footnote Series B Preferred Stock 2021-11-15 4 C 0 2218469 0.00 D Common Stock 2218469 0 I See footnote Series B Preferred Stock 2021-11-15 4 C 0 151690 0.00 D Common Stock 151690 0 I See footnote Series B-1 Preferred Stock 2021-11-15 4 C 0 1122344 0.00 D Common Stock 1122344 0 I See footnote Series B-1 Preferred Stock 2021-11-15 4 C 0 76740 0.00 D Common Stock 76740 0 I See footnote Series C Preferred Stock 2021-11-15 4 C 0 433917 0.00 D Common Stock 433917 0 I See footnote Series C Preferred Stock 2021-11-15 4 C 0 29669 0.00 D Common Stock 29669 0 I See footnote Series D Preferred Stock 2021-11-15 4 C 0 40375 0.00 D Common Stock 40375 0 I See footnote Series D Preferred Stock 2021-11-15 4 C 0 2761 0.00 D Common Stock 2761 0 I See footnote Each share of the Series B Preferred Stock, Series B-1 Preferred Stock, Series C Preferred Stock and Series D Preferred Stock automatically converted into shares of Common Stock immediately prior to the closing of the Issuer's initial public offering, on a 1:1 basis, and has no expiration date. Shares are held by Pelion Ventures VI, L.P. ("PV VI"). Pelion Venture Partners VI, L.L.C. ("PVP VI") is the sole general partner of PV VI. The Reporting Person is the managing director of PVP VI and may be deemed to exercise voting and dispositive power over the shares held by PV VI. The Reporting Person disclaims beneficial ownership of the shares held by PV VI except to the extent of his pecuniary interest therein. Shares are held by Pelion Ventures VI-A, L.P. ("PV VI-A"). PVP VI is the sole general partner of PV VI-A. The Reporting Person is the managing director of PVP VI and may be deemed to exercise voting and dispositive power over the shares held by PV VI-A. The Reporting Person disclaims beneficial ownership of the shares held by PV VI-A except to the extent of his pecuniary interest therein. Shares are held by Pelion Ventures VII, L.P. ("PV VII"). Pelion Venture Partners VII, L.L.C. ("PVP VII") is the sole general partner of PV VII. The Reporting Person is a managing director of PVP VII and may be deemed to share voting and dispositive power over the shares held by PV VII. The Reporting Person disclaims beneficial ownership of the shares held by PV VII except to the extent of his pecuniary interest therein. /s/ Blake G. Modersitzki 2021-11-17