-----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, HaSTX1/wSAicf8Fjlc0l5wtWGl+xPEM7BXnSlXujKaeZAk3R/uay1qrs9pxcbMnC +VdJ0MOezwdI1MdZIvJloQ== 0000909954-04-000056.txt : 20041001 0000909954-04-000056.hdr.sgml : 20041001 20041001154001 ACCESSION NUMBER: 0000909954-04-000056 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20040930 FILED AS OF DATE: 20041001 DATE AS OF CHANGE: 20041001 ISSUER: 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 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 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: DAVIS WILLIAM D CENTRAL INDEX KEY: 0001224777 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-12340 FILM NUMBER: 041058554 BUSINESS ADDRESS: STREET 1: C/O GREEN MOUNTAIN COFFEE ROASTERS INC STREET 2: 33 COFFEE LANE CITY: WATERBURY STATE: VT ZIP: 05676 BUSINESS PHONE: 8022445621 MAIL ADDRESS: STREET 1: C/O GREEN MOUNTAIN COFFEE ROASTERS INC STREET 2: 33 COFFEE LANE CITY: WATERBURY STATE: VT ZIP: 05676 4 1 primary_doc.xml PRIMARY DOCUMENT X0202 4 2004-09-30 0 0000909954 GREEN MOUNTAIN COFFEE ROASTERS INC gmcr 0001224777 DAVIS WILLIAM D C/O GREEN MOUNTAIN COFFEE ROASTERS INC 33 COFFEE LANE WATERBURY VT 05676 1 0 0 0 GMCR Phantom Stock Units 2004-09-30 4 A 0 380.59 21.02 A 2004-09-30 GMCR Common Stock 380.59 1376.11 D 1-for-1 On September 30, 2004, Mr. Davis acquired 380.59 phantom stock units at a price of $21.02 as a result of fee deferral under the Company's 2002 Deferred Compensation Plan. Distributions are made under the Plan following the participants' death, disability, or termination of service. Distributions are payable in a lump sum or in no more than 15 annual installments, at the election of the participant. /s/ William D. Davis 2004-10-01 -----END PRIVACY-ENHANCED MESSAGE-----