0001866581-23-000112.txt : 20230814 0001866581-23-000112.hdr.sgml : 20230814 20230814160412 ACCESSION NUMBER: 0001866581-23-000112 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20230811 FILED AS OF DATE: 20230814 DATE AS OF CHANGE: 20230814 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Tullett Victoria J CENTRAL INDEX KEY: 0001606719 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-40798 FILM NUMBER: 231169693 MAIL ADDRESS: STREET 1: C/O DUTCH BROS INC. STREET 2: 110 SW 4TH STREET CITY: GRANTS PASS STATE: OR ZIP: 97526 FORMER NAME: FORMER CONFORMED NAME: Blackwell Victoria T. DATE OF NAME CHANGE: 20140429 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Dutch Bros Inc. CENTRAL INDEX KEY: 0001866581 STANDARD INDUSTRIAL CLASSIFICATION: RETAIL-EATING & DRINKING PLACES [5810] IRS NUMBER: 871041305 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 110 SW 4TH STREET CITY: GRANTS PASS STATE: OR ZIP: 97526 BUSINESS PHONE: (206) 390-8860 MAIL ADDRESS: STREET 1: PO BOX 1929 CITY: GRANTS PASS STATE: OR ZIP: 97528-0163 4 1 wf-form4_169204344021277.xml FORM 4 X0508 4 2023-08-11 0 0001866581 Dutch Bros Inc. BROS 0001606719 Tullett Victoria J C/O DUTCH BROS INC. PO BOX 1929 GRANTS PASS OR 97528-0163 0 1 0 0 Chief Legal Officer 0 Class A Common Stock 2023-08-11 4 P 0 739 33.80 A 739 D /s/ Charles Jemley, Attorney-in-Fact for Victoria Tullett 2023-08-14