SEC Form 3
FORM 3 | UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES 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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1. Name and Address of Reporting Person*
(Street)
| 2. Date of Event Requiring Statement (Month/Day/Year) 07/09/2018 | 3. Issuer Name and Ticker or Trading Symbol Keurig Dr Pepper Inc. [ KDP ] | |||||||||||||
4. Relationship of Reporting Person(s) to Issuer (Check all applicable)
| 5. If Amendment, Date of Original Filed (Month/Day/Year) | ||||||||||||||
6. Individual or Joint/Group Filing (Check Applicable Line)
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Table I - Non-Derivative Securities Beneficially Owned | |||
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1. Title of Security (Instr. 4) | 2. Amount of Securities Beneficially Owned (Instr. 4) | 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) | 4. Nature of Indirect Beneficial Ownership (Instr. 5) |
Common Stock, par value $0.01 per share | 1,005,923,440 | D(1) |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||
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1. Title of Derivative Security (Instr. 4) | 2. Date Exercisable and Expiration Date (Month/Day/Year) | 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) | 4. Conversion or Exercise Price of Derivative Security | 5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) | 6. Nature of Indirect Beneficial Ownership (Instr. 5) | ||
Date Exercisable | Expiration Date | Title | Amount or Number of Shares |
1. Name and Address of Reporting Person*
(Street)
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1. Name and Address of Reporting Person*
(Street)
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1. Name and Address of Reporting Person*
(Street)
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1. Name and Address of Reporting Person*
(Street)
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1. Name and Address of Reporting Person*
(Street)
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1. Name and Address of Reporting Person*
(Street)
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1. Name and Address of Reporting Person*
(Street)
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1. Name and Address of Reporting Person*
(Street)
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1. Name and Address of Reporting Person*
(Street)
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Explanation of Responses: |
1. The shares of common stock, par value $0.01 per share, of Keurig Dr Pepper Inc. described in this report are held by Maple Holdings B.V. ("Maple Holdings"), an indirect subsidiary or each other Reporting Person herein. As such, each other Reporting Person herein may be deemed to beneficially own such shares held by Maple Holdings. |
Remarks: |
/s/ Merel Broers, Director of Maple Holdings B.V.; /s/ Leo Burgers, Director of Maple Holdings B.V. | 07/19/2018 | |
/s/ Joachim Creus, Proxy Holder of Acorn Holdings B.V. | 07/19/2018 | |
/s/ Merel Broers, Director of JAB Forest B.V.; /s/ Constantin Thun, Director of JAB Forest B.V. | 07/19/2018 | |
/s/ Markus Hopmann, Manager of JAB Investments s.a r.l.; /s/ Joachim Creus, Manager of JAB Investments s.a r.l. | 07/19/2018 | |
/s/ Merel Broers, Director of JAB Holdings B.V.; /s/ Constantin Thun, Director of JAB Holdings B.V. | 07/19/2018 | |
/s/ Markus Hopmann, Manager of JAB Holding Company s.a r.l.; /s/ Joachim Creus, Manager of JAB Holding Company s.a r.l. | 07/19/2018 | |
/s/ Merel Broers, Director of Donata Holdings B.V.; /s/ Constantin Thun, Director of Donata Holdings B.V. | 07/19/2018 | |
/s/ Joachim Creus, Authorized Representative of Lucresca SE | 07/19/2018 | |
/s/ Joachim Creus, Authorized Representative of Agnaten SE | 07/19/2018 | |
** 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 5 (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. |