0000899243-21-030376.txt : 20210728 0000899243-21-030376.hdr.sgml : 20210728 20210728171333 ACCESSION NUMBER: 0000899243-21-030376 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20210726 FILED AS OF DATE: 20210728 DATE AS OF CHANGE: 20210728 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Margolis Harry CENTRAL INDEX KEY: 0001871729 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-40630 FILM NUMBER: 211123593 MAIL ADDRESS: STREET 1: 15821 VENTURA BLVD., SUITE 145 CITY: ENCINO STATE: CA ZIP: 91436 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Zevia PBC CENTRAL INDEX KEY: 0001854139 STANDARD INDUSTRIAL CLASSIFICATION: BOTTLED & CANNED SOFT DRINKS CARBONATED WATERS [2086] IRS NUMBER: 862862492 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 15821 VENTURA BLVD. STREET 2: SUITE 145 CITY: ENCINO STATE: CA ZIP: 91436 BUSINESS PHONE: (310) 202-7000 MAIL ADDRESS: STREET 1: 15821 VENTURA BLVD. STREET 2: SUITE 145 CITY: ENCINO STATE: CA ZIP: 91436 4 1 doc4.xml FORM 4 SUBMISSION X0306 4 2021-07-26 0 0001854139 Zevia PBC ZVIA 0001871729 Margolis Harry C/O ZEVIA PBC 15821 VENTURA BLVD., SUITE 145 ENCINO CA 91436 0 1 0 0 Chief Operating Officer Stock Option (Right to Buy) 0.01 2021-07-26 4 D 0 4920 13.045 D 2028-12-31 Class A Common Stock 4920 135672 I By Margolis Family Trust Represents 4,920 vested options cancelled and cashed-out by mutual agreement of the Reporting Person and the Issuer. The Reporting Person received $13.045 per stock option and $64,181.40 total as consideration for the cancellation. /s/ Lorna R. Simms, Attorney-in-Fact for Harry Margolis 2021-07-28