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