0000909954-11-000074.txt : 20111003 0000909954-11-000074.hdr.sgml : 20111003 20111003155516 ACCESSION NUMBER: 0000909954-11-000074 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20110930 FILED AS OF DATE: 20111003 DATE AS OF CHANGE: 20111003 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: DAFT DOUGLAS N CENTRAL INDEX KEY: 0001019420 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-12340 FILM NUMBER: 111120217 MAIL ADDRESS: STREET 1: C/O GREEN MOUNTAIN COFFEE STREET 2: 33 COFFEE LANE CITY: WATERBURY STATE: VT ZIP: 05676 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: 0929 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 4 1 primary_doc.xml PRIMARY DOCUMENT X0304 4 2011-09-30 0 0000909954 GREEN MOUNTAIN COFFEE ROASTERS INC GMCR 0001019420 DAFT DOUGLAS N C/O GREEN MOUNTAIN COFFEE 33 COFFEE LANE WATERBURY VT 05676 1 0 0 0 GMCR Phantom Stock Units 2011-09-30 4 A 0 115.67 92.94 A 2011-09-30 GMCR Common Stock 115.67 2449 D 1 for 1 On 09/30/2011, Mr. Daft acquired 115.67 units of Phantom Stock at a unit price of $92.94 as a result of fee deferral. Distribution is made under the Deferred Compensation Plan at the time of the participant's death, disability, or termination of services. /s/ Valerie Jennings pursuant to a Power of Attorney 2011-10-03