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*
Neubauer Florence

(Last) (First) (Middle)
C/O ZEVIA PBC
15821 VENTURA BLVD., SUITE 145

(Street)
ENCINO CA 91436

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
08/14/2023
3. Issuer Name and Ticker or Trading Symbol
Zevia PBC [ ZVIA ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director 10% Owner
X Officer (give title below) Other (specify below)
Interim CFO
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)
Class A Common Stock 35,250(1) D
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)
Date Exercisable Expiration Date Title Amount or Number of Shares
Stock Option (Right to Buy) (2) 10/06/2032 Class A Common Stock 16,502 $4.6 D
Stock Option (Right to Buy) (3) 03/17/2033 Class A Common Stock 40,650 $3 D
Explanation of Responses:
1. Includes 35,250 restricted stock units ("RSUs") granted under the Zevia PBC 2021 Equity Incentive Plan (the "2021 Plan"). Each RSU represents the right to receive one share of Class A Common Stock of the Issuer. 10,870 RSUs begin vesting in 1/4 increments on each anniversary of October 6, 2023 and are settled within 30 days following each vesting date. 24,380 RSUs begin vesting in 1/4 increments on each anniversary of March 17, 2024 and are settled within 30 days following each vesting date.
2. Represents options to purchase Class A common Stock of the Issuer granted under the 2021 Plan. These options vest in 1/4 increments on each anniversary of October 6, 2023.
3. Represents options to purchase Class A common Stock of the Issuer granted under the 2021 Plan. These options vest in 1/4 increments on each anniversary of March 17, 2024.
Remarks:
/s/ Lorna R. Simms, Attorney-in-Fact for Florence Neubauer 08/24/2023
** 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.
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