Sec Form 4 Filing - Modersitzki Blake G @ Weave Communications, Inc. - 2021-11-15

Insider filing report for Changes in Beneficial Ownership
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FORM 4
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP
Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(h) of the Investment Company Act of 1940
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1. Name and Address of Reporting Person
Modersitzki Blake G
2. Issuer Name and Ticker or Trading Symbol
Weave Communications, Inc. [ WEAV]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X __ Director _____ 10% Owner
_____ Officer (give title below) _____ Other (specify below)
(Last) (First) (Middle)
2750 E. COTTONWOOD PARK, SUITE 600
3. Date of Earliest Transaction (MM/DD/YY)
11/15/2021
(Street)
SALT LAKE CITY, UT84121
4. If Amendment, Date Original Filed (MM/DD/YY)
6. Individual or Joint/Group Filing (Check Applicable Line)
__ X __ Form filed by One Reporting Person
_____ Form filed by More than One Reporting Person
(City) (State) (Zip)
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
1.Title of Security
(Instr. 3)
2. Transaction Date (MM/DD/YY) 2A. Deemed Execution Date, if any (MM/DD/YY) 3. Transaction Code
(Instr. 8)
4. Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
5. Amount of Securities Beneficially Owned Following Reported Transaction(s)
(Instr. 3 and 4)
6. Ownership Form: Direct (D) or Indirect (I)
(Instr. 4)
7. Nature of Indirect Beneficial Ownership
(Instr. 4)
Code V Amount (A) or (D) Price
Common Stock 11/15/2021 C 3,815,105 A 4,219,889 I See footnote( 2 )
Common Stock 11/15/2021 C 260,860 A 288,538 I See footnote( 3 )
Common Stock 11/15/2021 P 315,900 A $ 24 4,535,789 I See footnote( 2 )
Common Stock 11/15/2021 P 21,600 A $ 24 310,138 I See footnote( 3 )
Common Stock 11/15/2021 P 62,500 A $ 24 699,444 I See footnote( 4 )
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
( e.g. , puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security
(Instr. 3)
2. Conversion or Exercise Price of Derivative Security 3. Transaction Date (MM/DD/YY) 3A. Deemed Execution Date, if any (MM/DD/YY) 4. Transaction Code
(Instr. 8)
5. Number of Derivative Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4, and 5)
6. Date Exercisable and Expiration Date
(MM/DD/YY)
7. Title and Amount of Underlying Securities
(Instr. 3 and 4)
8. Price of Derivative Security
(Instr. 5)
9. Number of Derivative Securities Beneficially Owned Following Reported Transaction(s)
(Instr. 4)
10. Ownership Form of Derivative Security: Direct (D) or Indirect (I)
(Instr. 4)
11. Nature of Indirect Beneficial Ownership
(Instr. 4)
Code V (A) (D) Date Exercisable Expiration Date Title Amount or Number of Shares
Series B Preferred Stock ( 1 ) 11/15/2021 C 2,218,469 ( 1 ) ( 1 ) Common Stock 2,218,469 $ 0 0 I See footnote( 2 )
Series B Preferred Stock ( 1 ) 11/15/2021 C 151,690 ( 1 ) ( 1 ) Common Stock 151,690 $ 0 0 I See footnote( 3 )
Series B-1 Preferred Stock ( 1 ) 11/15/2021 C 1,122,344 ( 1 ) ( 1 ) Common Stock 1,122,344 $ 0 0 I See footnote( 2 )
Series B-1 Preferred Stock ( 1 ) 11/15/2021 C 76,740 ( 1 ) ( 1 ) Common Stock 76,740 $ 0 0 I See footnote( 3 )
Series C Preferred Stock ( 1 ) 11/15/2021 C 433,917 ( 1 ) ( 1 ) Common Stock 433,917 $ 0 0 I See footnote( 2 )
Series C Preferred Stock ( 1 ) 11/15/2021 C 29,669 ( 1 ) ( 1 ) Common Stock 29,669 $ 0 0 I See footnote( 3 )
Series D Preferred Stock ( 1 ) 11/15/2021 C 40,375 ( 1 ) ( 1 ) Common Stock 40,375 $ 0 0 I See footnote( 2 )
Series D Preferred Stock ( 1 ) 11/15/2021 C 2,761 ( 1 ) ( 1 ) Common Stock 2,761 $ 0 0 I See footnote( 3 )
Reporting Owners
Reporting Owner Name / Address Relationships
Director 10% Owner Officer Other
Modersitzki Blake G
2750 E. COTTONWOOD PARK, SUITE 600
SALT LAKE CITY, UT84121
X
Signatures
/s/ Blake G. Modersitzki 11/17/2021
Signature of Reporting Person Date
Explanation of Responses:
( 1 )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.( 2 )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.
( 3 )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.
( 4 )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.

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