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