| 1. Name and Address of Reporting Person * Kobza Joshua | 2. Issuer Name and Ticker or Trading Symbol Restaurant Brands International Inc. [ QSR ] |
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
_____ Director _____ 10% Owner __X__ Officer (give title below) _____ Other (specify below) COO |
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3. Date of Earliest Transaction
(MM/DD/YYYY)
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4. If Amendment, Date Original Filed
(MM/DD/YYYY)
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6. Individual or Joint/Group Filing
(Check Applicable Line)
_X
_ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person |
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Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned |
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1.Title of Security (Instr. 3) |
2. Trans. Date | 2A. Deemed Execution Date, if any |
3. Trans. 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 | ||||||
| Common Shares | 245496 | D | ||||||||
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Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) |
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1. Title of Derivate Security (Instr. 3) |
2. Conversion or Exercise Price of Derivative Security | 3. Trans. Date | 3A. Deemed Execution Date, if any |
4. Trans. 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 |
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 of Derivative Security: 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 | ||||||||
| Exchangeable units (1) | (1) | (1) | (1) | Common Shares | 5413 | 5413 | D | ||||||||
| Option (right to buy) | $42.26 | 12/31/2019 | 3/5/2025 | Common Shares | 35494 | 35494 | D | ||||||||
| Option (right to buy) | $42.26 | 3/6/2020 | 3/5/2025 | Common Shares | 300000 | 300000 | D | ||||||||
| Restricted Share Units | (2) | (3) | (3) | Common Shares | 26730 | 26730 | D | ||||||||
| Dividend Equivalent Rights | (4) | 10/3/2019 | A | 203.5244 | (5) | (5) | Common Shares | 203.5244 | $0.00 | 2239.6644 | D | ||||
| Performance Share Units | (6) | 2/26/2021 | 2/26/2021 | Common Shares | 353500 | 353500 | D | ||||||||
| Dividend Equivalent Rights | (4) | 10/3/2019 | A | 2691.3499 | (7) | (7) | Common Shares | 2691.3499 | $0.00 | 29586.7404 | D | ||||
| Restricted Share Units | (2) | (8) | (8) | Common Shares | 20114 | 20114 | D | ||||||||
| Dividend Equivalent Rights | (4) | 10/3/2019 | A | 150.9577 | (9) | (9) | Common Shares | 150.9577 | $0.00 | 1373.3143 | D | ||||
| Option (right to buy) | $56.92 | 5/5/2022 | 5/4/2027 | Common Shares | 200000 | 200000 | D | ||||||||
| Restricted Share Units | (2) | (10) | (10) | Common Shares | 17111 | 17111 | D | ||||||||
| Dividend Equivalent Rights | (4) | 10/3/2019 | A | 126.7942 | (11) | (11) | Common Shares | 126.7942 | $0.00 | 936.8866 | D | ||||
| Restricted Share Units | (2) | (12) | (12) | Common Shares | 13313 | 13313 | D | ||||||||
| Dividend Equivalent Rights | (4) | 10/3/2019 | A | 95.5934 | (13) | (13) | Common Shares | 95.5934 | $0.00 | 293.7658 | D | ||||
| Performance Share Units | (14) | 2/22/2024 | 2/22/2024 | Common Shares | 225000 | 225000 | D | ||||||||
| Dividend Equivalent Rights | (15) | 10/3/2019 | A | 1615.6026 | (16) | (16) | Common Shares | 1615.6026 | $0.00 | 4964.8693 | D | ||||
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Reporting Owners |
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| Reporting Owner Name / Address |
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| Director | 10% Owner | Officer | Other | ||
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Kobza Joshua 130 KING STREET WEST SUITE 300 TORONTO, A6 M5X 1E1 |
COO | ||||
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Signatures |
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| /s/ Lisa Giles-Klein, As Attorney-in-Fact for Joshua Kobza | 10/4/2019 | |
| **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 control number. | |