# EDGAR Filing Document

**Accession Number:** 0002068577
**File Stem:** 0001493152-25-013589
**Filing Date:** 2025-9
**Character Count:** 10395
**Document Hash:** e4c82ff8a4926870c6b57d0b8ae6cb17
**Contains OCR:** False
**Source Format:** 

## Filing Content

## Filing Summary
**0001493152-25-013589.hdr.sgml**: 20250915

**ACCESSION NUMBER**: 0001493152-25-013589

**CONFORMED SUBMISSION TYPE**: 4

**PUBLIC DOCUMENT COUNT**: 1

**CONFORMED PERIOD OF REPORT**: 20250915

**FILED AS OF DATE**: 20250915

**DATE AS OF CHANGE**: 20250915

**REPORTING-OWNER**: 

**OWNER DATA:**
- **COMPANY CONFORMED NAME:** Viking Cake BR, LLC
- **CENTRAL INDEX KEY:** 0002083841

**ORGANIZATION NAME:**
- **STATE OF INCORPORATION:** DE
- **FISCAL YEAR END:** 1231

**FILING VALUES:**
- **FORM TYPE:** 4
- **SEC ACT:** 1934 Act
- **SEC FILE NUMBER:** 001-42844
- **FILM NUMBER:** 251315529

**BUSINESS ADDRESS:**
- **STREET 1:** 9170 E. BAHIA DRIVE
- **STREET 2:** SUITE 101
- **CITY:** SCOTTSDALE
- **STATE:** AZ
- **ZIP:** 85260
- **BUSINESS PHONE:** 503-970-3376

**MAIL ADDRESS:**
- **STREET 1:** 9170 E. BAHIA DRIVE
- **STREET 2:** SUITE 101
- **CITY:** SCOTTSDALE
- **STATE:** AZ
- **ZIP:** 85260
**REPORTING-OWNER**: 

**OWNER DATA:**
- **COMPANY CONFORMED NAME:** Viking Cake Fuel, LLC
- **CENTRAL INDEX KEY:** 0002084799

**ORGANIZATION NAME:**
- **STATE OF INCORPORATION:** DE
- **FISCAL YEAR END:** 1231

**FILING VALUES:**
- **FORM TYPE:** 4
- **SEC ACT:** 1934 Act
- **SEC FILE NUMBER:** 001-42844
- **FILM NUMBER:** 251315528

**BUSINESS ADDRESS:**
- **STREET 1:** 18625 MACALPINE LOOP
- **STREET 2:** C/O VIKING CAKE BR, LLC
- **CITY:** BEND
- **STATE:** OR
- **ZIP:** 97702
- **BUSINESS PHONE:** 503-970-3376

**MAIL ADDRESS:**
- **STREET 1:** 18625 MACALPINE LOOP
- **STREET 2:** C/O VIKING CAKE BR, LLC
- **CITY:** BEND
- **STATE:** OR
- **ZIP:** 97702
**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 4

### 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>Viking Cake BR, LLC<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>2025-09-15 | **5. Relationship of Reporting Person(s) to Issuer**<br>(Check all applicable)<br>[ ] Director [X] 10% Owner<br>[ ] Officer (give title below) [ ] Other (specify below)<br>_ _ |
| **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>[ ] Form filed by One Reporting Person<br>[X] Form filed by More than One Reporting Person |

---

---

| | | |
|:---|:---|:---|
| **1. Name and Address of Reporting Person**<sup>*</sup><br>Viking Cake Fuel, LLC<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>2025-09-15 | **5. Relationship of Reporting Person(s) to Issuer**<br>(Check all applicable)<br>[ ] Director [X] 10% Owner<br>[ ] Officer (give title below) [ ] Other (specify below)<br>_ _ |
| **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>[ ] Form filed by One Reporting Person<br>[X] 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 |
|  |  |  |  |  |  |  |  |  |  |  |

---

## 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>(1)</sup> | 2025-09-15 |  | P |  | 3118938 |  | <sup>(1)</sup> | <sup>(1)</sup> | Class A Common Stock | 11618781 | $20.00 | 11618781 | I | See footnote<sup>(4)</sup> |
| Class C Common Stock | <sup>(2)(3)</sup> | 2025-09-15 |  | J<sup>(5)</sup> |  | 3118938 |  | <sup>(2)(3)</sup> | <sup>(2)(3)</sup> | Class A Common Stock | 11618781 | $0.00 | 11618781 | I | See footnote<sup>(4)</sup> |

---

### Footnotes:

(1) 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 Black Rock Coffee Bar, Inc. (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.

(2) 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.

(3) 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 Daniel Brand, Jeff Hernandez, Jake Spellmeyer and Bryan Pereboom (collectively, the "Co-Founders"), the date on which the aggregate number of shares of Class C Common Stock held by such Co-Founder or certain of their affiliates is less than thirty-three percent (33%) of the shares of Class C Common Stock held by such Co-Founder and certain of their 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.

(4) Held by Viking Cake BR, LLC and its wholly-owned subsidiary, Viking Cake Fuel, LLC.

(5) 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.

**Signature:** /s/ Sam Seiberling, Attorney in Fact for Viking Cake BR, LLC and Viking Cake Fuel, LLC  
**Date:** 2025-09-15

### 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.**