0001895949-24-000030.txt : 20240131 0001895949-24-000030.hdr.sgml : 20240131 20240131135509 ACCESSION NUMBER: 0001895949-24-000030 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20240129 FILED AS OF DATE: 20240131 DATE AS OF CHANGE: 20240131 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: 24582031 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: 24582032 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 primary_doc.xml PRIMARY DOCUMENT X0508 4 2024-01-29 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 2024-01-29 4 M 0 175000 0 A 236012 I Held through Mossytree Inc. Vacasa Holding Units 2024-01-29 4 M 0 175000 D Class A Common Stock 175000 2417758 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. Eric Breon 2024-01-31