SEC Form 4 · accession 0001209191-16-088100
Restaurant Brands International Inc. · QSR
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Alexandre Van Damme
Director
Period of report
Dec 31, 2015
Accepted (ET)
Jan 4, 2016 · 8:43 pm EST
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0001618756
Table I — non-derivative securities
| Security | Date | Code | Shares | Price | A/D | Owned after | D/I | Nature of ownership |
|---|---|---|---|---|---|---|---|---|
| Common SharesF1 | Dec 31, 2015 | A | 3,231 | $0.00 | A | 16,978 | D | |
| Common SharesF2 | holding | — | — | — | 5,200,000 | I | See Footnote |
Table II — derivative securities
| Security | Conv. / exercise price | Date | Code | Shares | A/D | Exercisable | Expires | Underlying | Underlying shares | Owned after | D/I |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Option (right to buy) | $3.98 | holding | — | — | — | Mar 1, 2017 | Feb 28, 2022 | Common Shares | 141,105 | 141,105 | D |
Explanation of responses
- F1Represents restricted stock units that are earned and vested upon grant and that settle upon termination of board service.
- F2Represents an indirect interest held by Societe Familiale d'Investissements. The Reporting Person is an indirect beneficial owner of equity interests in Societe Familiale d'Investissements. The Reporting Person disclaims beneficial ownership of any shares in which he does not have a pecuniary interest.