-----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, SM5d/bMhVzoEtyjIZ41YOYySGGc3IPtKK0dK+a9gXSVsAmKd+84IOq+xXP6t4BUF 62Fw7uAZ/filsSlzRrQTeA== 0000909954-04-000075.txt : 20041216 0000909954-04-000075.hdr.sgml : 20041216 20041216155041 ACCESSION NUMBER: 0000909954-04-000075 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20041214 FILED AS OF DATE: 20041216 DATE AS OF CHANGE: 20041216 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: PREVO JAMES K CENTRAL INDEX KEY: 0001096214 STANDARD INDUSTRIAL CLASSIFICATION: MISCELLANEOUS FOOD PREPARATIONS & KINDRED PRODUCTS [2090] STATE OF INCORPORATION: DE FISCAL YEAR END: 0928 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-12340 FILM NUMBER: 041208316 BUSINESS ADDRESS: STREET 1: C/O GREEN MOUNTAIN COFFEE INC STREET 2: 33 COFFEE LN CITY: WATERBURY STATE: VT ZIP: 05676 BUSINESS PHONE: 8022445621 MAIL ADDRESS: STREET 1: 33 COFFEE LANE CITY: WATERBURY STATE: VT ZIP: 05676 4 1 primary_doc.xml PRIMARY DOCUMENT X0202 4 2004-12-14 0 0000909954 GREEN MOUNTAIN COFFEE ROASTERS INC gmcr 0001096214 PREVO JAMES K 33 COFFEE LANE WATERBURY VT 05676 0 1 0 0 CIO GMCR Stock Option 23.56 2004-12-14 4 A 0 4000 0 A 2014-12-14 GMCr Common Stock 4000 78500 D Option vests in equal annual installments over 4 years. /s/ James K. Prevo 2004-12-16 -----END PRIVACY-ENHANCED MESSAGE-----