0001667731-23-000358.txt : 20230807 0001667731-23-000358.hdr.sgml : 20230807 20230807104545 ACCESSION NUMBER: 0001667731-23-000358 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20230803 FILED AS OF DATE: 20230807 DATE AS OF CHANGE: 20230807 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Breon Eric CENTRAL INDEX KEY: 0001890272 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-41130 FILM NUMBER: 231146086 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 STATE OF INCORPORATION: OR FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-41130 FILM NUMBER: 231146087 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] 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 2023-08-03 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 2023-08-03 4 S 0 100000 .70 D 978938 I Held through Mossytree Inc. Class A Common Stock 2023-08-04 4 S 0 100000 .70 D 878938 I Held through Mossytree Inc. 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 2023-08-07