SEC Form 4
FORM 4 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP

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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Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
1. Name and Address of Reporting Person*
Pelino Brigid V.

(Last) (First) (Middle)
4150 TULLER ROAD, UNIT 236

(Street)
DUBLIN OH 43017

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
Tim Hortons Inc. [ THI ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director 10% Owner
X Officer (give title below) Other (specify below)
Senior VP, Human Resources
3. Date of Earliest Transaction (Month/Day/Year)
05/15/2009
4. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
X Form filed by One Reporting Person
Form filed by More than One Reporting Person
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
1. Title of Security (Instr. 3) 2. Transaction Date (Month/Day/Year) 2A. Deemed Execution Date, if any (Month/Day/Year) 3. Transaction Code (Instr. 8) 4. Securities Acquired (A) or Disposed Of (D) (Instr. 3, 4 and 5) 5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4) 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 7. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V Amount (A) or (D) Price
Common Stock 05/15/2009 F 1,468.4644 D $24.47(1) 28,072.9764 D
Common Stock 05/15/2009 A 2,962 A $0 31,034.9764(2) D
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 3) 2. Conversion or Exercise Price of Derivative Security 3. Transaction Date (Month/Day/Year) 3A. Deemed Execution Date, if any (Month/Day/Year) 4. Transaction Code (Instr. 8) 5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) 6. Date Exercisable and Expiration Date (Month/Day/Year) 7. Title and Amount of Securities Underlying Derivative Security (Instr. 3 and 4) 8. Price of Derivative Security (Instr. 5) 9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) 10. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 11. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V (A) (D) Date Exercisable Expiration Date Title Amount or Number of Shares
Employee Stock Option with Tandem Stock Appreciation Right(3) $24.47(1) 05/15/2009 A 12,737 05/15/2010(3) 05/15/2016 Common Stock 12,737 $0 12,737 D
Explanation of Responses:
1. The U.S. price reported represents the approximate equivalent of Cdn.$28.87, as converted into U.S. dollars on the transaction date using the 3:30 p.m. buying rate of Philadelphia Stock Exchange for cable transfers payable in foreign currency, as certified for customs purposes by the Federal Reserve Bank of New York.
2. Aggregate securities benefically owned includes a trivial adjustment (of less than one share) to balance records with plan administrator. Total also includes additional restricted stock units (RSUs) acquired in connection with the automatic conversion of dividend equivalent rights (associated with outstanding RSUs) into additional RSUs after each quarterly dividend payment date.
3. Represents an option to purchase granted in tandem with a stock appreciation right for the number of shares of common stock set forth above under the Issuer's 2006 Stock Incentive Plan. Accordingly, the exercise of either the option or stock appreciation right results in the cancellation and surrender to the Company of the other. These rights are scheduled to vest in three equal annual installments commencing on May 15, 2010.
Jill E. Aebker, Attorney-in-Fact 05/19/2009
** Signature of Reporting Person Date
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).
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