UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(h) of the Investment Company Act of 1940 |
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | SEC 1473 (7-02) | ||
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 control number. |
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 of Derivative Security: Direct (D) or Indirect (I) (Instr. 5) |
6. Nature of Indirect Beneficial Ownership (Instr. 5) |
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Date Exercisable | Expiration Date | Title | Amount or Number of Shares |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
Maple Holdings B.V. OOSTERDOKSSTRAAT 80 AMSTERDAM, P7 1011 DK |
 |  X |  |  |
Acorn Holdings B.V. OOSTERDOKSSTRAAT 80 AMSTERDAM, P7 1011 DK |
 |  X |  |  |
JAB Forest B.V. OOSTERDOKSSTRAAT 80 AMSTERDAM, P7 1011 DK |
 |  X |  |  |
JAB Investments S.a r.l. OOSTERDOKSSTRAAT 80 AMSTERDAM, P7 1011 DK |
 |  X |  |  |
JAB Holdings B.V. OOSTERDOKSSTRAAT 80 AMSTERDAM, P7 1011 DK |
 |  X |  |  |
JAB Holding Co s.a r.l. OOSTERDOKSSTRAAT 80 AMSTERDAM, P7 1011 DK |
 |  X |  |  |
Donata Holdings B.V. OOSTERDOKSSTRAAT 80 AMSTERDAM, P7 1011 DK |
 |  X |  |  |
Lucresca SE ROOSEVELTPLATZ 4-5 TOP 10 VIENNA, C4 1090 |
 |  X |  |  |
Agnaten SE ROOSEVELTPLATZ 4-5 TOP 10 VIENNA, C4 1090 |
 |  X |  |  |
/s/ Merel Broers, Director of Maple Holdings B.V.; /s/ Leo Burgers, Director of Maple Holdings B.V. | 07/19/2018 | |
**Signature of Reporting Person | Date | |
/s/ Joachim Creus, Proxy Holder of Acorn Holdings B.V. | 07/19/2018 | |
**Signature of Reporting Person | Date | |
/s/ Merel Broers, Director of JAB Forest B.V.; /s/ Constantin Thun, Director of JAB Forest B.V. | 07/19/2018 | |
**Signature of Reporting Person | Date | |
/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 | |
**Signature of Reporting Person | Date | |
/s/ Merel Broers, Director of JAB Holdings B.V.; /s/ Constantin Thun, Director of JAB Holdings B.V. | 07/19/2018 | |
**Signature of Reporting Person | Date | |
/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 | |
**Signature of Reporting Person | Date | |
/s/ Merel Broers, Director of Donata Holdings B.V.; /s/ Constantin Thun, Director of Donata Holdings B.V. | 07/19/2018 | |
**Signature of Reporting Person | Date | |
/s/ Joachim Creus, Authorized Representative of Lucresca SE | 07/19/2018 | |
**Signature of Reporting Person | Date | |
/s/ Joachim Creus, Authorized Representative of Agnaten SE | 07/19/2018 | |
**Signature of Reporting Person | Date |
* | 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). |
(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. |