0001209191-22-001082.txt : 20220104
0001209191-22-001082.hdr.sgml : 20220104
20220104180030
ACCESSION NUMBER: 0001209191-22-001082
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20211230
FILED AS OF DATE: 20220104
DATE AS OF CHANGE: 20220104
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Sicupira Carlos Alberto
CENTRAL INDEX KEY: 0001552490
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-36786
FILM NUMBER: 22508027
MAIL ADDRESS:
STREET 1: 5505 BLUE LAGOON DRIVE
CITY: MIAMI
STATE: FL
ZIP: 33126
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: Restaurant Brands International Inc.
CENTRAL INDEX KEY: 0001618756
STANDARD INDUSTRIAL CLASSIFICATION: RETAIL-EATING PLACES [5812]
IRS NUMBER: 000000000
STATE OF INCORPORATION: Z4
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 130 KING STREET WEST
STREET 2: SUITE 300
CITY: TORONTO
STATE: A6
ZIP: M5X 1E1
BUSINESS PHONE: (905) 845-6511
MAIL ADDRESS:
STREET 1: 130 KING STREET WEST
STREET 2: SUITE 300
CITY: TORONTO
STATE: A6
ZIP: M5X 1E1
FORMER COMPANY:
FORMER CONFORMED NAME: 9060669 Canada Inc.
DATE OF NAME CHANGE: 20141028
FORMER COMPANY:
FORMER CONFORMED NAME: 1011773 B.C. Unlimited Liability Co
DATE OF NAME CHANGE: 20140905
4
1
doc4.xml
FORM 4 SUBMISSION
X0306
4
2021-12-30
0
0001618756
Restaurant Brands International Inc.
QSR
0001552490
Sicupira Carlos Alberto
130 KING STREET WEST
SUITE 300
TORONTO
A6
M5X 1E1
ONTARIO, CANADA
1
0
0
0
Common Shares
2021-12-30
4
A
0
2318
0.00
A
142642
D
Common Shares
779090
I
See Footnote
Exchangeable units
Common Shares
1500000
1500000
I
See Footnote
Represents restricted stock units that are earned and vested upon grant and that settle upon termination of board service.
Represents 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.
Each 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.
/s/ Michele Keusch, as attorney-in-fact for Carlos Alberto Sicupira
2022-01-04