Jeffrey Robert Hernandez - 28 Dec 2025 Form 4 Insider Report for Black Rock Coffee Bar, Inc.

Reporting relationship: Director, 10%+ Owner
Issuer ticker: BRCB on Nasdaq
Reported as of: 28 Dec 2025
Net transaction value: $0
SEC form: 4
Accepted by SEC: 29 Dec 2025, 17:14:03 UTC
Prior SEC filing: 16 Sep 2025
Next SEC filing: 23 Mar 2026
Source filing: View source filing
Reporting owner signature: /s/ Sam Seiberling, Attorney in Fact for Jeffrey Hernandez

Key filing fact

Jeffrey Robert Hernandez filed Form 4 for Black Rock Coffee Bar, Inc. on 29 Dec 2025.

Key facts

This page summarizes Jeffrey Robert Hernandez's Form 4 filing for Black Rock Coffee Bar, Inc..
4 reported transactions and 4 derivative rows are listed below.
Accepted by SEC: 29 Dec 2025, 17:14.

Change

Previous filing in this sequence was filed on 16 Sep 2025.
Current net transaction value: $0.

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 0002083544 Primary reporting owner

Hernandez Jeffrey Robert

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 Jeffrey Hernandez
Signature date: 29 Dec 2025

Reported derivative securities

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

BRCB transaction Derivative

LLC Units

Gift

Transaction value: $0
Shares: +243,860
Change %
Price: $0.000000
Shares after: 243,860
Date: 28 Dec 2025
Ownership: Direct
Underlying class: Class A Common Stock
Underlying amount: 243,860
Exercise price
Footnotes: F1, F2

BRCB transaction Derivative

Class C Common Stock

Gift

Transaction value: $0
Shares: +243,860
Change %
Price: $0.000000
Shares after: 243,860
Date: 28 Dec 2025
Ownership: Direct
Underlying class: Class A Common Stock
Underlying amount: 243,860
Exercise price
Footnotes: F2, F3, F4

BRCB transaction Derivative

LLC Units

Gift

Transaction value: $0
Shares: -243,860
Change %: -100%
Price: $0.000000
Shares after: 0
Date: 28 Dec 2025
Ownership: Direct
Underlying class: Class A Common Stock
Underlying amount: 243,860
Exercise price
Footnotes: F1, F5

BRCB transaction Derivative

Class C Common Stock

Gift

Transaction value: $0
Shares: -243,860
Change %: -100%
Price: $0.000000
Shares after: 0
Date: 28 Dec 2025
Ownership: Direct
Underlying class: Class A Common Stock
Underlying amount: 243,860
Exercise price
Footnotes: F3, F4, F5

^* marks a reported price that did not pass the local price check.

Additional SEC filing notes

Filing notes and footnotes

Explanation of responses 5 footnotes

Footnote F1

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 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 F2

On December 28, 2025, the Reporting Person received 243,860 LLC Units and 243,860 shares of Class C Common Stock pursuant to a distribution to the Reporting Person as beneficiary of the Jeffrey R. Hernandez 2021 Irrevocable Trust.

Footnote F3

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 F4

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) September 15, 2035 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 September 15, 2025.

Footnote F5

On December 28, 2025, the Reporting Person gifted 243,860 LLC Units and 243,860 shares of Class C Common Stock (which shares automatically converted to shares of Class B Common Stock) to NCF Charitable Assets Trust, a donor advised fund. These shares remain subject to a Lock-Up Agreement for a period of 180 days after the date of the final prospectus relating to the public offering of the Issuer's Class A Common Stock (the "IPO"), as required pursuant to a Lock-Up Agreement the Reporting Person entered into with the underwriters in connection with the IPO. The Reporting Person does not have a pecuniary interest in the securities held by NCF Charitable Assets Trust.