SEC Form 4 · accession 0001209191-17-061648

Restaurant Brands International Inc. · QSR

Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗

Reporting owner

Director

Period of report

Nov 15, 2017

Accepted (ET)

Nov 17, 2017 · 7:30 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 Shares	holding	—	—		—	19,482	D
Common Shares^F1	holding	—	—		—	5,419,230	I	See Footnote

Security	Conv. / exercise price	Date	Code	Shares	A/D	Exercisable	Expires	Underlying	Underlying shares	Owned after	D/I
Exchangeable units^F2,F1	—	Nov 15, 2017	J	2,858,895	A	—	—	Common Shares	2,858,895	2,858,895	I

F1Represents 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.
F2Each Restaurant Brands International Limited Partnership exchangeable unit is convertible, at the Reporting Person's election, into common shares of Restaurant Brands International Inc. or a cash amount equal to a prescribed cash amount determined by reference to the weighted average trading price of Restaurant Brands International Inc.'s common shares on the New York Stock Exchange for the 20 consecutive trading days ending on the last business day prior to the exchange date, at the sole discretion of the general partner of Restaurant Brands International Limited Partnership (subject to the consent of the Restaurant Brands International Inc. conflicts committee, in certain circumstances). This conversion right has no expiration date.
F3Represents a distribution from 3G Restaurant Brands Holdings LP, of which Societe Familiale d'Investissementsto is a limited partner.