Blake G Modersitzki Form 3 Weave Communications / Blake G Modersitzki ownership change

SEC Form 3

FORM 3

UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES

Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934
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

(Last)

(First)

(Middle)

2750 E. COTTONWOOD PARK, SUITE 600

(Street)

SALT LAKE CITY

84121

(City)

(State)

(Zip)

2. Date of Event Requiring Statement (Month/Day/Year)
11/10/2021

3. Issuer Name and Ticker or Trading Symbol
Weave Communications, Inc. [ WEAV ]

4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)

X	Director	10% Owner
	Officer (give title below)	Other (specify below)

5. If Amendment, Date of Original Filed (Month/Day/Year)

6. Individual or Joint/Group Filing (Check Applicable Line)

X	Form filed by One Reporting Person
	Form filed by More than One Reporting Person

Table I - Non-Derivative Securities Beneficially Owned
1. Title of Security (Instr. 4)	2. Amount of Securities Beneficially Owned (Instr. 4)	3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5)	4. Nature of Indirect Beneficial Ownership (Instr. 5)
Common Stock	404,784	I	See footnote⁽¹⁾
Common Stock	27,678	I	See footnote⁽²⁾
Common Stock	636,944	I	See footnote⁽³⁾

Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 4)	2. Date Exercisable and Expiration Date (Month/Day/Year)		3. Title and Amount of Securities Underlying Derivative Security (Instr. 4)		4. Conversion or Exercise Price of Derivative Security	5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5)	6. Nature of Indirect Beneficial Ownership (Instr. 5)
1. Title of Derivative Security (Instr. 4)	Date Exercisable	Expiration Date	Title	Amount or Number of Shares	4. Conversion or Exercise Price of Derivative Security	5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5)	6. Nature of Indirect Beneficial Ownership (Instr. 5)
Series B Preferred Stock	⁽⁴⁾	⁽⁴⁾	Common Stock	2,218,469⁽⁴⁾	⁽⁴⁾	I	See footnote⁽¹⁾
Series B Preferred Stock	⁽⁴⁾	⁽⁴⁾	Common Stock	151,690⁽⁴⁾	⁽⁴⁾	I	See footnote⁽²⁾
Series B-1 Preferred Stock	⁽⁴⁾	⁽⁴⁾	Common Stock	1,122,344⁽⁴⁾	⁽⁴⁾	I	See footnote⁽¹⁾
Series B-1 Preferred Stock	⁽⁴⁾	⁽⁴⁾	Common Stock	76,740⁽⁴⁾	⁽⁴⁾	I	See footnote⁽²⁾
Series C Preferred Stock	⁽⁴⁾	⁽⁴⁾	Common Stock	433,917⁽⁴⁾	⁽⁴⁾	I	See footnote⁽¹⁾
Series C Preferred Stock	⁽⁴⁾	⁽⁴⁾	Common Stock	29,669⁽⁴⁾	⁽⁴⁾	I	See footnote⁽²⁾
Series D Preferred Stock	⁽⁴⁾	⁽⁴⁾	Common Stock	40,375⁽⁴⁾	⁽⁴⁾	I	See footnote⁽¹⁾
Series D Preferred Stock	⁽⁴⁾	⁽⁴⁾	Common Stock	2,761⁽⁴⁾	⁽⁴⁾	I	See footnote⁽²⁾

Explanation of Responses:

1. 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.

2. 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.

3. 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.

4. Each share of Series B Preferred Stock, Series B-1 Preferred Stock, Series C Preferred Stock and Series D Preferred Stock will automatically convert into shares of Common Stock on a 1:1 basis immediately prior to the closing of the Issuer's initial public offering and has no expiration date.

Remarks:

	/s/ Blake G. Modersitzki	11/10/2021
	** Signature of Reporting Person	Date
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
* If the form is filed by more than one reporting person, see Instruction 5 (b)(v).
** Intentional misstatements or omissions of facts constitute Federal Criminal Violations See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure.
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number.

Blake G Modersitzki Form 3Weave Communications / Blake G Modersitzki ownership change