# EDGAR Filing Document

**Accession Number:** 0002077880
**File Stem:** 0001493152-25-017138
**Filing Date:** 2025-10
**Character Count:** 6481
**Document Hash:** d689a1a51992fa1a1acc597155baf06d
**Contains OCR:** False
**Source Format:** 

## Filing Content

## Filing Summary
**0001493152-25-017138.hdr.sgml**: 20251006

**ACCESSION NUMBER**: 0001493152-25-017138

**CONFORMED SUBMISSION TYPE**: 3/A

**PUBLIC DOCUMENT COUNT**: 1

**CONFORMED PERIOD OF REPORT**: 20250912

**FILED AS OF DATE**: 20251006

**DATE AS OF CHANGE**: 20251006

**REPORTING-OWNER**: 

**OWNER DATA:**
- **COMPANY CONFORMED NAME:** Booth Rodderick Fredrick
- **CENTRAL INDEX KEY:** 0002077880

**ORGANIZATION NAME:**

**FILING VALUES:**
- **FORM TYPE:** 3/A
- **SEC ACT:** 1934 Act
- **SEC FILE NUMBER:** 001-42844
- **FILM NUMBER:** 251377788

**MAIL ADDRESS:**
- **STREET 1:** C/O BLACK ROCK COFFEE BAR, INC.
- **STREET 2:** 9170 E. BAHIA DRIVE, SUITE 101
- **CITY:** SCOTTSDALE
- **STATE:** AZ
- **ZIP:** 85260
**ISSUER**: 

**COMPANY DATA:**
- **COMPANY CONFORMED NAME:** Black Rock Coffee Bar, Inc.
- **CENTRAL INDEX KEY:** 0002068577
- **STANDARD INDUSTRIAL CLASSIFICATION:** RETAIL-EATING & DRINKING PLACES [5810]
- **ORGANIZATION NAME:** 07 Trade & Services
- **EIN:** 000000000
- **STATE OF INCORPORATION:** DE
- **FISCAL YEAR END:** 1231

**BUSINESS ADDRESS:**
- **STREET 1:** 9170 E. BAHLA DRIVE, SUITE 101
- **CITY:** SCOTTSDALE
- **STATE:** AZ
- **ZIP:** 85260
- **BUSINESS PHONE:** (458) 256-9668

**MAIL ADDRESS:**
- **STREET 1:** 9170 E. BAHLA DRIVE, SUITE 101
- **CITY:** SCOTTSDALE
- **STATE:** AZ
- **ZIP:** 85260

### UNITED STATES SECURITIES AND EXCHANGE COMMISSION
**Washington, D.C. 20549**

## FORM 3/A

### STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP

[ ] Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).

[ ] Check this box to indicate that a transaction was made pursuant to a contract, instruction or written plan for the purchase or sale of equity securities of the issuer that is intended to satisfy the affirmative defense conditions of Rule 10b5-1(c). See Instruction 10.

---

| | | |
|:---|:---|:---|
| **1. Name and Address of Reporting Person**<sup>*</sup><br>Booth Rodderick Fredrick<br><sub>(Last) (First) (Middle)</sub><br>C/O BLACK ROCK COFFEE BAR, INC.<br>9170 E. BAHIA DRIVE, SUITE 101<br><sub>(Street)</sub><br>SCOTTSDALE, AZ 85260<br><sub>(City) (State) (Zip)</sub> | **3. Date of Earliest Transaction (Month/Day/Year)**<br>2025-09-12 | **5. Relationship of Reporting Person(s) to Issuer**<br>(Check all applicable)<br>[ ] Director [ ] 10% Owner<br>[X] Officer (give title below) [ ] Other (specify below)<br>_Chief Financial Officer_ |
| **2. Issuer Name and Ticker or Trading Symbol**<br>Black Rock Coffee Bar, Inc. [ BRCB ] | **4. If Amendment, Date of Original Filed (Month/Day/Year)**<br>  | **6. Individual or Joint/Group Filing (Check Applicable Line)**<br>[X] Form filed by One Reporting Person<br>[ ] Form filed by More than One Reporting Person |

---

## Table I - Non-Derivative Securities

---

|  |  |  |  |  |  |  |  |  |  |  |
| --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- |
| 1. Title of Security | 2. Transaction Date | 2A. Deemed Execution Date | 3. Transaction Code (V) | 3. Transaction Code (V) | 4. Securities Acquired (A) or Disposed of (D) | 4. Securities Acquired (A) or Disposed of (D) | 4. Securities Acquired (A) or Disposed of (D) | 5. Amount of Securities Beneficially Owned | 6. Ownership Form | 7. Nature of Indirect Beneficial Ownership |
| 1. Title of Security | 2. Transaction Date | 2A. Deemed Execution Date | Code | V | Amount | (A) or (D) | Price | 5. Amount of Securities Beneficially Owned | 6. Ownership Form | 7. Nature of Indirect Beneficial Ownership |
| Class B Common Stock |  |  |  |  |  |  |  | 349826<sup>(1)</sup> | D |  |

---

## Table II - Derivative Securities

---

|  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |
| --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- |
| 1. Title of Derivative Security | 2. Conversion or Exercise Price | 3. Transaction Date | 3A. Deemed Execution Date | 4. Transaction Code (V) | 4. Transaction Code (V) | 5. Number of Derivative Securities Acquired (A) or Disposed of (D) | 5. Number of Derivative Securities Acquired (A) or Disposed of (D) | 6. Date Exercisable and Expiration Date | 6. Date Exercisable and Expiration Date | 7. Title and Amount of Underlying Securities | 7. Title and Amount of Underlying Securities | 8. Price of Derivative Security | 9. Number of Derivative Securities Beneficially Owned | 10. Ownership Form | 11. Nature of Indirect Beneficial Ownership |
| 1. Title of Derivative Security | 2. Conversion or Exercise Price | 3. Transaction Date | 3A. Deemed Execution Date | Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | 8. Price of Derivative Security | 9. Number of Derivative Securities Beneficially Owned | 10. Ownership Form | 11. Nature of Indirect Beneficial Ownership |
| LLC Units | <sup>(2)</sup> |  |  |  |  |  |  | <sup>(2)</sup> | <sup>(2)</sup> | Class A Common Stock | 349826<sup>(1)</sup> |  |  | D |  |

---

### Footnotes:

(1) This amendment is being filed to correct the number of LLC Units and corresponding shares of Class B Common Stock beneficially owned by the Reporting Person at the time of the original Form 3 filing. The error also carried forward to the Reporting Person's Form 4 filed on September 15, 2025. As reported herein, on September 12, 2025, the Reporting Person beneficially owned 349,826 LLC Units and shares of Class B Common Stock.

(2) The LLC Units may be redeemed by the Reporting Person at any time at the option of the holder for shares of Class A Common Stock on a 1-to-1 basis, and a corresponding number of shares of Class B Common Stock will be forfeited in connection with the redemption. The LLC Units have no expiration date.

**Signature:** /s/ Sam Seiberling, Attorney-in-Fact  
**Date:** 2025-10-06

### Remarks:

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 Number.**