0001667731-23-000508.txt : 20231228 0001667731-23-000508.hdr.sgml : 20231228 20231228161559 ACCESSION NUMBER: 0001667731-23-000508 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20231226 FILED AS OF DATE: 20231228 DATE AS OF CHANGE: 20231228 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Breon Eric CENTRAL INDEX KEY: 0001890272 ORGANIZATION NAME: FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-41130 FILM NUMBER: 231522881 MAIL ADDRESS: STREET 1: 201 SW DOGWOOD LN CITY: WHITE SALMON STATE: WA ZIP: 98672 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Mossytree Inc. CENTRAL INDEX KEY: 0001895949 ORGANIZATION NAME: STATE OF INCORPORATION: OR FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-41130 FILM NUMBER: 231522882 BUSINESS ADDRESS: STREET 1: 201 SW DOGWOOD LN CITY: WHITE SALMON STATE: WA ZIP: 98672 BUSINESS PHONE: 208-791-1255 MAIL ADDRESS: STREET 1: 201 SW DOGWOOD LN CITY: WHITE SALMON STATE: WA ZIP: 98672 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Vacasa, Inc. CENTRAL INDEX KEY: 0001874944 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-TO DWELLINGS & OTHER BUILDINGS [7340] ORGANIZATION NAME: 07 Trade & Services IRS NUMBER: 000000000 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 850 NW 13TH AVENUE CITY: PORTLAND STATE: OR ZIP: 097209 BUSINESS PHONE: (800) 544-0300 MAIL ADDRESS: STREET 1: 850 NW 13TH AVENUE CITY: PORTLAND STATE: OR ZIP: 097209 4 1 s61223mossytreereporting.xml X0508 4 2023-12-26 0 0001874944 Vacasa, Inc. VCSA 0001895949 Mossytree Inc. 201 SW DOGWOOD LN WHITE SALMON WA 98672 0 0 1 0 0001890272 Breon Eric 201 SW DOGWOOD LN WHITE SALMON WA 98672 0 0 1 0 0 Class A Common Stock 2023-12-26 4 M 0 100000 0 A 123006 I Held through Mossytree Inc. Class A Common Stock 2023-12-26 4 S 0 5000 8.10 D 118006 I Held through Mossytree Inc. Class A Common Stock 2023-12-27 4 S 0 5000 7.93 D 113006 I Held through Mossytree Inc. Class A Common Stock 2023-12-28 4 S 0 5000 7.94 D 108006 I Held through Mossytree Inc. Vacasa Holdings Units 2023-12-26 4 M 0 100000 0 D Class A Common Stock 100000 2592758 I Held through Mossytree Inc. The term "Vacasa Holdings Units" is used herein to represent limited liability company units of Vacasa Holdings LLC and an equal number of paired shares of Class B common stock of the Issuer, which, pursuant to the limited liability company agreement of Vacasa Holdings LLC, are together redeemable by the holder on a one-for-one basis for, at the option of the Issuer (i) a share of Class A common stock, subject to conversion rate adjustments for stock splits, stock dividends, reclassification and other similar transactions or (ii) an equivalent amount of cash. Upon the redemption of the units, the Issuer cancelled and retired for no consideration an equivalent number of shares of Class B common stock and Vacasa Holdings LLC registered the Issuer as the owner of the redeemed units. Shares of Class B common stock of the Issuer have no economic rights and each share of Class B common stock entitles its holder to 1 vote per share. Eric Breon is the President of Mossytree Inc. As a result, Mr. Breon may be deemed to share beneficial ownership of the shares held directly by Mossytree Inc. /s/ Charles Bolland 2023-12-28