Bryan Douglas Pereboom - 15 Sep 2025 Form 4 Insider Report for Black Rock Coffee Bar, Inc.

Source evidence Original filing metadata and source links for verification. 5 source fields
SEC form
4
Accepted by SEC
16 Sep 2025, 07:02:48 UTC
Prior SEC filing
12 Sep 2025
Next SEC filing
27 Oct 2025
Source filing
View source filing
Reporting owner 1 detail
Reporting owner signature
/s/ Sam Seiberling, Attorney in Fact for Bryan Pereboom

Key filing fact

Bryan Douglas Pereboom filed Form 4 for Black Rock Coffee Bar, Inc. on 16 Sep 2025.

Key facts

  • This page summarizes Bryan Douglas Pereboom's Form 4 filing for Black Rock Coffee Bar, Inc..
  • 3 reported transactions and 2 derivative rows are listed below.
  • Accepted by SEC: 16 Sep 2025, 07:02.

Change

  • Previous filing in this sequence was filed on 12 Sep 2025.
  • Current net transaction value: +$62,378,760.

Research use

  • This tells you what this filing adds before you inspect full transaction and derivative tables.
  • You can trace every row back to the original SEC filing document.

Evidence

Filed on Form 4

Ownership activity is grounded in SEC Form 4 disclosures.

View source filing

Reporting Owners (1)

CIK 0002080000 Primary reporting owner

Pereboom Bryan Douglas

Relationship
Director, 10%+ Owner
Address
C/O BLACK ROCK COFFEE BAR, INC., 9170 E. BAHIA DRIVE, SUITE 101, SCOTTSDALE
Signature
/s/ Sam Seiberling, Attorney in Fact for Bryan Pereboom
Signature date
16 Sep 2025

Reported non-derivative transactions

Shares, units, or other non-derivative securities reported in this filing.

BRCB transaction

Class A Common Stock

Award

Transaction value
Shares
+2,812
Change %
Price
Shares after
2,812
Date
11 Sep 2025
Ownership
Direct
Footnotes
F1, F2

Reported derivative securities

Options, warrants, convertible securities, or similar derivative positions disclosed in the filing.

BRCB transaction Derivative

LLC Units

Purchase

Transaction value
$62,378,760
Shares
+3,118,938
Change %
+37%
Price
$20.00
Shares after
11,618,781
Date
15 Sep 2025
Ownership
See footnote
Underlying class
Class A Common Stock
Underlying amount
11,618,781
Exercise price
Footnotes
F3, F6
BRCB transaction Derivative

Class C Common Stock

Other

Transaction value
$0
Shares
+3,118,938
Change %
+37%
Price
$0.000000
Shares after
11,618,781
Date
15 Sep 2025
Ownership
See footnote
Underlying class
Class A Common Stock
Underlying amount
11,618,781
Exercise price
Footnotes
F4, F5, F6, F7
* marks a reported price that did not pass the local price check.

Additional SEC filing notes

Filing notes and footnotes

Explanation of responses 7 footnotes

Footnote F1

This transaction occurred prior to Black Rock Coffee Bar, Inc.'s (the "Issuer") registration of a class of equity securities under Section 12 of the Securities Exchange Act of 1934, as amended, in connection with the Issuer's initial public offering, and is reported herein pursuant to Rule 16a-2(a).

Footnote F2

Represents an award of restricted stock units ("RSUs"), each of which represents a contingent right to receive one share of Class A Common Stock. The RSUs vest in full on the earlier of the Issuer's 2026 annual meeting or the first anniversary of the closing of the Issuer's initial public offering.

Footnote F3

LLC units ("LLC Units") represent the membership units of Black Rock Coffee Holdings, LLC ("Black Rock OpCo") and an equal number of shares of Class C common stock ("Class C Common Stock") of the Issuer. Holders may elect to have Black Rock OpCo redeem their LLC Units at any time on or following the closing of the Issuer's initial public offering for either shares of Class A common stock ("Class A Common Stock") on a one-for-one basis or, at the Issuer's election (determined solely by the Issuer's independent directors who are disinterested), a corresponding amount of cash, in either case, contributed to Black Rock OpCo by the Issuer, unless the Issuer elects, in its sole discretion (determined solely by the Issuer's independent directors who are disinterested), to effect such transaction as a direct exchange with the relevant holder. Upon any such redemption or exchange of LLC Units, the corresponding shares of Class C Common Stock will be cancelled.

Footnote F4

The Class C Common Stock is convertible at any time, at the holder's election, into Class A Common Stock on a one-for-one basis; provided that, at the Issuer's election (determined solely by the Issuer's independent directors who are disinterested), the Issuer may effect such exchange for a cash payment equal to a volume weighted average market price of one share of Class A Common Stock for each LLC Unit so redeemed.

Footnote F5

Each outstanding share of Class C Common Stock will automatically convert into one share of the Issuer's Class B common stock upon the earlier of (i) the ten-year anniversary of the later of the closing of the Issuer's initial public offering or the closing date of any exercise of the underwriters' option to purchase additional shares of Class A Common Stock and (ii) with respect to the Reporting Person, the date on which the aggregate number of shares of Class C Common Stock held by the Reporting Person or certain of his affiliates is less than thirty-three percent (33%) of the shares of Class C Common Stock held by the Reporting Person and certain of his affiliates as of the later of the closing of the Issuer's initial public offering or the closing date of any exercise of the underwriters' option to purchase additional shares of Class A Common Stock in the Issuer's initial public offering.

Footnote F6

Held by Viking Cake BR, LLC ("Viking Cake") and its wholly-owned subsidiary, Viking Cake Fuel, LLC, for which the Reporting Person has voting and investment power. The Reporting Person disclaims beneficial ownership of the shares held by Viking Cake except to the extent of his pecuniary interest therein.

Footnote F7

Represents a corresponding number of shares of Class C Common Stock issued in connection with the purchase of newly-issued LLC Units from Black Rock OpCo.

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