SEC Form 4
FORM 4 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP

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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Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
  
Check this box to indicate that a transaction was made pursuant to a contract, instruction or written plan for the purchase or sale of equity securities of the issuer that is intended to satisfy the affirmative defense conditions of Rule 10b5-1(c). See Instruction 10.
1. Name and Address of Reporting Person*
Boersma Travis

(Last) (First) (Middle)
C/O DUTCH BROS INC.
110 SW 4TH STREET

(Street)
GRANTS PASS OR 97526

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
Dutch Bros Inc. [ BROS ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director X 10% Owner
X Officer (give title below) Other (specify below)
Executive Chairman of Board
3. Date of Earliest Transaction (Month/Day/Year)
09/22/2021
4. 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 Acquired, Disposed of, or Beneficially Owned
1. Title of Security (Instr. 3) 2. Transaction Date (Month/Day/Year) 2A. Deemed Execution Date, if any (Month/Day/Year) 3. Transaction Code (Instr. 8) 4. Securities Acquired (A) or Disposed Of (D) (Instr. 3, 4 and 5) 5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4) 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 7. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V Amount (A) or (D) Price
Class A Common Stock 11/15/2021 P 19.3603 A $62.01 19.3603 I By Son(1)
Class A Common Stock 11/15/2021 S 19.3603 D $62.24 0 I By Son(1)
Class A Common Stock 05/18/2022 P 107.9481 A $24.89 107.9481 I By Son(1)
Class A Common Stock 05/27/2022 S 1.4508 D $37.59(2) 106.4972 I By Son(1)
Class A Common Stock 05/27/2022 P 1.4781 A $36.89 107.9754 I By Son(1)
Class A Common Stock 09/01/2022 P 29.0477 A $34.43(3) 137.0231 I By Son(1)
Class A Common Stock 09/13/2022 P 41.9693 A $35.74(4) 178.9924 I By Son(1)
Class A Common Stock 01/06/2023 S 100 D $30 78.9924 I By Son(1)
Class A Common Stock 01/09/2023 S 78 D $31.4 0.9924 I By Son(1)
Class A Common Stock 03/01/2023 P 255 A $32 255.9924 I By Son(1)
Class A Common Stock 03/07/2023 P 1.9831 A $33.73 257.9755 I By Son(1)
Class A Common Stock 03/27/2023 S 25.4496 D $29.44 232.5259 I By Son(1)
Class A Common Stock 03/27/2023 P 25.4331 A $29.45 257.959 I By Son(1)
Class A Common Stock 04/14/2023 S 128.972 D $32.1 128.987 I By Son(1)
Class A Common Stock 05/10/2023 P 130.3816 A $29.8(5) 259.3686 I By Son(1)
Class A Common Stock 08/03/2023 S 136.1934 D $29.36 123.1752 I By Son(1)
Class A Common Stock 08/08/2023 S 27.3423 D $27.43 95.8329 I By Son(1)
Class A Common Stock 08/08/2023 P 2.4696 A $27.51 98.3025 I By Son(1)
Class A Common Stock 08/08/2023 P 10.8456 A $27.66 109.1482 I By Son(1)
Class A Common Stock 08/09/2023 S 109.1482 D $30.72(6) 0 I By Son(1)
Class A Common Stock 15,610 I By DM Trust Aggregator, LLC
Class A Common Stock 9,817 I By DM Individual Aggregator, LLC
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 3) 2. Conversion or Exercise Price of Derivative Security 3. Transaction Date (Month/Day/Year) 3A. Deemed Execution Date, if any (Month/Day/Year) 4. Transaction Code (Instr. 8) 5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) 6. Date Exercisable and Expiration Date (Month/Day/Year) 7. Title and Amount of Securities Underlying Derivative Security (Instr. 3 and 4) 8. Price of Derivative Security (Instr. 5) 9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) 10. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 11. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V (A) (D) Date Exercisable Expiration Date Title Amount or Number of Shares
Call Option (Right to Buy) $60 09/22/2021 P 1 09/22/2021 10/15/2021 Class A Common Stock 100 $440 1 I By Son(1)
Call Option (Right to Buy) $60 09/22/2021 S 1 09/22/2021 10/15/2021 Class A Common Stock 100 $399.98 0 I By Son(1)
Call Option (Right to Buy) $40 10/05/2021 P 1 10/05/2021 10/15/2021 Class A Common Stock 100 $430 1 I By Son(1)
Call Option (Right to Buy) $40 10/07/2021 S 1 10/05/2021 10/15/2021 Class A Common Stock 100 $479.98 0 I By Son(1)
Put Option (Right to Sell) $60 10/19/2021 P 1 10/19/2021 11/19/2021 Class A Common Stock 100 $500 1 I By Son(1)
Put Option (Right to Sell) $60 10/21/2021 S 1 10/19/2021 11/19/2021 Class A Common Stock 100 $569.98 0 I By Son(1)
Put Option (Right to Sell) $41 02/21/2023 P 2 02/21/2023 02/24/2023 Class A Common Stock 200 $401 2 I By Son(1)
Put Option (Right to Sell) $41 02/21/2023 P 4 02/21/2023 02/24/2023 Class A Common Stock 400 $400 6 I By Son(1)
Put Option (Right to Sell) $41 02/21/2023 P 1 02/21/2023 03/03/2024 Class A Common Stock 100 $420 1 I By Son(1)
Put Option (Right to Sell) $41 02/24/2023 S 4 02/21/2023 02/24/2023 Class A Common Stock 400 $789.98 2 I By Son(1)
Put Option (Right to Sell) $41 02/24/2023 S 2 02/21/2023 02/24/2023 Class A Common Stock 200 $809.98 0 I By Son(1)
Put Option (Right to Sell) $41 03/01/2023 S 1 02/21/2023 03/03/2024 Class A Common Stock 100 $819.98 0 I By Son(1)
Put Option (Right to Sell) $33 05/09/2023 P 5 05/09/2023 05/12/2023 Class A Common Stock 500 $210 5 I By Son(1)
Put Option (Right to Sell) $33 05/09/2023 S 5 05/09/2023 05/12/2023 Class A Common Stock 500 $200 0 I By Son(1)
Put Option (Right to Sell) $33 05/09/2023 P 1 05/09/2023 05/12/2023 Class A Common Stock 100 $205 1 I By Son(1)
Put Option (Right to Sell) $33 05/10/2023 S 1 05/09/2023 05/12/2023 Class A Common Stock 100 $299.98 0 I By Son
Call Option (Right to Buy) $26 08/08/2023 P 3 08/08/2023 08/11/2023 Class A Common Stock 300 $230 3 I By Son(1)
Call Option (Right to Buy) $26 08/08/2023 S 1 08/08/2023 08/11/2023 Class A Common Stock 100 $239.98 2 I By Son(1)
Call Option (Right to Buy) $26 08/09/2023 S 2 08/08/2023 08/11/2023 Class A Common Stock 200 $549.99 0 I By Son(1)
Explanation of Responses:
1. Pursuant to Section 16 reporting requirements, the Form 4 reflects purchases and sales of the Issuer's Class A common stock and derivative securities that were made by the Reporting Person's adult son. The amount of profit realized by the applicable short-swing transactions is approximately $8,500 and has been paid to the Issuer, as required. The Reporting Person was recently notified of the transactions by his son, resulting in today's filing. This report shall not be deemed an admission by the Reporting Person that he is the beneficial owner of any of the securities traded by his adult son, other than for purposes of Section 16.
2. Represents weighted average sales price. The shares were sold at prices ranging from $37.56 to $37.60. The Reporting Person will provide upon request, to the SEC, the Issuer or security holder of the Issuer, full information regarding the number of shares sold at each separate price.
3. Represents weighted average purchase price. The shares were sold at prices ranging from $34.39 to $34.43. The Reporting Person will provide upon request, to the SEC, the Issuer or security holder of the Issuer, full information regarding the number of shares purchased at each separate price.
4. Represents weighted average purchase price. The shares were sold at prices ranging from $35.39 to $35.92. The Reporting Person will provide upon request, to the SEC, the Issuer or security holder of the Issuer, full information regarding the number of shares purchased at each separate price.
5. Represents weighted average purchase price. The shares were sold at prices ranging from $29.76 to $29.80. The Reporting Person will provide upon request, to the SEC, the Issuer or security holder of the Issuer, full information regarding the number of shares purchased at each separate price.
6. Represents weighted average sales price. The shares were sold at prices ranging from $30.72 to $30.78. The Reporting Person will provide upon request, to the SEC, the Issuer or security holder of the Issuer, full information regarding the number of shares sold at each separate price.
Remarks:
By Travis Boersma 08/29/2023
** 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 4 (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.
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number.