SEC Form 4 · accession 0001209191-19-000411
Restaurant Brands International Inc. · QSR
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Carlos Alberto Sicupira
Director
Period of report
Dec 29, 2018
Accepted (ET)
Jan 2, 2019 · 6:00 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 29, 2018 | A | 2,692 | $0.00 | A | 59,355 | D | |
| Common SharesF2 | holding | — | — | — | 779,090 | 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Exchangeable unitsF3,F2 | — | holding | — | — | — | — | — | Common Shares | 1,500,000 | 1,500,000 | I |
| Option (right to buy)F4 | $3.54 | holding | — | — | — | — | Feb 2, 2021 | Common Shares | 106,050 | 106,050 | 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 CHL Investment Fund Ltd. The Reporting Person is an indirect beneficial owner of equity interests in CHL Investment Fund Ltd. The Reporting Person disclaims beneficial ownership of any shares in which he does not have a pecuniary interest.
- F3Each 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.
- F4These options are immediately exercisable.