Initial Statement of Beneficial Ownership (3)
July 19 2018 - 5:20PM
Edgar (US Regulatory)
FORM 3
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES
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OMB APPROVAL
OMB Number:
3235-0104
Estimated average burden
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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
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Maple Holdings B.V.
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2. Date of Event Requiring Statement (MM/DD/YYYY)
7/9/2018
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3. Issuer Name
and
Ticker or Trading Symbol
Keurig Dr Pepper Inc. [KDP]
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(Last)
(First)
(Middle)
OOSTERDOKSSTRAAT 80,
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4. Relationship of Reporting Person(s) to Issuer (Check all applicable)
_____ Director
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X
___ 10% Owner
_____ Officer (give title below)
_____ Other (specify below)
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(Street)
AMSTERDAM, P7 1011 DK
(City)
(State)
(Zip)
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5. If Amendment, Date Original Filed
(MM/DD/YYYY)
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6. Individual or Joint/Group Filing
(Check Applicable Line)
___ Form filed by One Reporting Person
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X
_ Form filed by More than One Reporting Person
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Table I - Non-Derivative Securities Beneficially Owned
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1.Title of Security
(Instr. 4)
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2. Amount of Securities Beneficially Owned
(Instr. 4)
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3. Ownership Form: Direct (D) or Indirect (I)
(Instr. 5)
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4. Nature of Indirect Beneficial Ownership
(Instr. 5)
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Common Stock, par value $0.01 per share
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1005923440
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D
(1)
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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. 4)
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2. Date Exercisable and Expiration Date
(MM/DD/YYYY)
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3. Title and Amount of Securities Underlying Derivative Security
(Instr. 4)
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4. Conversion or Exercise Price of Derivative Security
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5. Ownership Form of Derivative Security: Direct (D) or Indirect (I)
(Instr. 5)
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6. Nature of Indirect Beneficial Ownership
(Instr. 5)
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Date Exercisable
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Expiration Date
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Title
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Amount or Number of Shares
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Explanation of Responses:
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(1)
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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.
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Reporting Owners
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Reporting Owner Name / Address
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Relationships
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Director
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10% Owner
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Officer
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Other
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Maple Holdings B.V.
OOSTERDOKSSTRAAT 80
AMSTERDAM, P7 1011 DK
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X
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Acorn Holdings B.V.
OOSTERDOKSSTRAAT 80
AMSTERDAM, P7 1011 DK
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X
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JAB Forest B.V.
OOSTERDOKSSTRAAT 80
AMSTERDAM, P7 1011 DK
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X
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JAB Investments S.a r.l.
OOSTERDOKSSTRAAT 80
AMSTERDAM, P7 1011 DK
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X
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JAB Holdings B.V.
OOSTERDOKSSTRAAT 80
AMSTERDAM, P7 1011 DK
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X
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JAB Holding Co s.a r.l.
OOSTERDOKSSTRAAT 80
AMSTERDAM, P7 1011 DK
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X
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Donata Holdings B.V.
OOSTERDOKSSTRAAT 80
AMSTERDAM, P7 1011 DK
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X
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Lucresca SE
ROOSEVELTPLATZ 4-5
TOP 10
VIENNA, C4 1090
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X
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Agnaten SE
ROOSEVELTPLATZ 4-5
TOP 10
VIENNA, C4 1090
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X
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Signatures
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/s/ Merel Broers, Director of Maple Holdings B.V.; /s/ Leo Burgers, Director of Maple Holdings B.V.
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7/19/2018
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**
Signature of Reporting Person
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Date
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/s/ Joachim Creus, Proxy Holder of Acorn Holdings B.V.
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7/19/2018
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Signature of Reporting Person
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Date
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/s/ Merel Broers, Director of JAB Forest B.V.; /s/ Constantin Thun, Director of JAB Forest B.V.
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7/19/2018
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**
Signature of Reporting Person
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Date
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/s/ Markus Hopmann, Manager of JAB Investments s.a r.l.; /s/ Joachim Creus, Manager of JAB Investments s.a r.l.
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7/19/2018
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**
Signature of Reporting Person
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Date
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/s/ Merel Broers, Director of JAB Holdings B.V.; /s/ Constantin Thun, Director of JAB Holdings B.V.
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7/19/2018
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**
Signature of Reporting Person
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Date
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/s/ Markus Hopmann, Manager of JAB Holding Company s.a r.l.; /s/ Joachim Creus, Manager of JAB Holding Company s.a r.l.
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7/19/2018
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**
Signature of Reporting Person
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Date
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/s/ Merel Broers, Director of Donata Holdings B.V.; /s/ Constantin Thun, Director of Donata Holdings B.V.
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7/19/2018
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**
Signature of Reporting Person
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Date
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/s/ Joachim Creus, Authorized Representative of Lucresca SE
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7/19/2018
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**
Signature of Reporting Person
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Date
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/s/ Joachim Creus, Authorized Representative of Agnaten SE
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7/19/2018
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**
Signature of Reporting Person
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Date
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
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*
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If the form is filed by more than one reporting person,
see
Instruction 5(b)(v).
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**
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Intentional misstatements or omissions of facts constitute Federal Criminal Violations.
See
18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
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Note:
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File three copies of this Form, one of which must be manually signed. If space is insufficient,
see
Instruction 6 for procedure.
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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.
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