-----BEGIN PRIVACY-ENHANCED MESSAGE----- Proc-Type: 2001,MIC-CLEAR Originator-Name: webmaster@www.sec.gov Originator-Key-Asymmetric: MFgwCgYEVQgBAQICAf8DSgAwRwJAW2sNKK9AVtBzYZmr6aGjlWyK3XmZv3dTINen TWSM7vrzLADbmYQaionwg5sDW3P6oaM5D3tdezXMm7z1T+B+twIDAQAB MIC-Info: RSA-MD5,RSA, Axxz7gDIl5+MgZisj8OQnbVYCOd4mgtLcGyaEgtfzv2YnU87VZHViUy+cpNuoofz CdpHnuDAIgX534xQBs/RZQ== 0000909954-03-000011.txt : 20030411 0000909954-03-000011.hdr.sgml : 20030411 20030411102611 ACCESSION NUMBER: 0000909954-03-000011 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20030407 FILED AS OF DATE: 20030411 REPORTING-OWNER: COMPANY DATA: COMPANY CONFORMED NAME: RATHKE FRANCES G CENTRAL INDEX KEY: 0001226477 RELATIONSHIP: OFFICER FILING VALUES: FORM TYPE: 3 MAIL ADDRESS: STREET 1: C/O GREEN MOUNTAIN COFFEE ROASTERS, INC. STREET 2: 33 COFFEE LANE CITY: WATERBURY STATE: VT ZIP: 05676 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: GREEN MOUNTAIN COFFEE ROASTERS INC CENTRAL INDEX KEY: 0000909954 STANDARD INDUSTRIAL CLASSIFICATION: MISCELLANEOUS FOOD PREPARATIONS & KINDRED PRODUCTS [2090] IRS NUMBER: 030339228 STATE OF INCORPORATION: DE FISCAL YEAR END: 0928 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-12340 FILM NUMBER: 03646392 BUSINESS ADDRESS: STREET 1: 33 COFFEE LANE CITY: WATERBURY STATE: VT ZIP: 05676 BUSINESS PHONE: 8022445621 MAIL ADDRESS: STREET 1: 33 COFFEE LANE CITY: WATERBURY STATE: VT ZIP: 05676 FORMER COMPANY: FORMER CONFORMED NAME: GREEN MOUNTAIN COFFEE INC DATE OF NAME CHANGE: 19930729 3 1 form3.htm FORM 3 FORM3

U.S. SECURITIES AND EXCHANGE COMMISSION
Washington, DC 20549

FORM 3

INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITES

Filed pursuant to Sections 16(a) of the Securities Exchange Act of 1934,
Sections 17(a) of the Public Utility Holding Company Act of 1935 or
Sections 30(h) of the Investment Company Act of 1940

 

1. Name and Address of Reporting Person*

Rathke  Frances  G

(Last)

(First)

(Middle)

 c/o Green Mountain Coffee Roasters, Inc.    33 Coffee Lane

(Street)
 Waterbury VT 05676

(City)

(State)

(Zip)

2. Date of Event Requiring Statement (Month/Day/Year)

4/7/03

3. IRS Identification Number of Reporting Person, if an Entity (Voluntary)

4. Issuer Name and Ticker or Trading Symbol

Green Mountain Coffee Roasters, Inc. -- GMCR

5. Relationship of Reporting Person to Issuer

(Check all applicable)

[_] Director [_] 10% Owner

[X] Officer (give title below) [_] Other (specify below)

Chief Financial Officer

6. If Amendment, Date of Original (Month/Day/Year)

7. Individual or Joint/Group Filing (Check applicable line)

[X] Form filed by one Reporting Person
[_] Form filed by more than one Reporting Person

 

FORM 3 (continued)

Table I -- Non-Derivative Securities Beneficially Owned

1. Title of Security (Instr. 4)

2. Amount of Securities Beneficially Owned (Instr. 4)

3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5)

4. Nature of Indirect Beneficial Ownership (Instr. 5)
none      
       
       
       
       
       
       
       

 

Table II -- Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)

1. Title of Derivative Security (Instr. 4)

2. Date Exercisable and Expiration Date (mm/dd/yy)

3. Title and Amount of Underlying Derivative Security
(Instr. 4)

4. Conversion or Exercise Price of Derivative Security

5. Ownership Form of Derivative Securities: Direct (D) or Indirect (I)
(Instr. 5)

6. Nature of Indirect Beneficial Ownership (Instr. 5)

Date Exer-
cisable

Expira-
tion Date

Title

Amount or Number of Shares
none              
               
               
               
               
               
               
               

Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.

(Print or Type Response)

Explanation of Responses:

/s/ Frances G. Rathke

4/11/03

**Signature of Reporting Person

Date

* If the Form is filed by more than one Reporting Person, see Instruction 5(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 provided is insufficient, see Instruction 6 for procedure.

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