0000909954-12-000075.txt : 20121203 0000909954-12-000075.hdr.sgml : 20121203 20121203103628 ACCESSION NUMBER: 0000909954-12-000075 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20121130 FILED AS OF DATE: 20121203 DATE AS OF CHANGE: 20121203 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: CARLINI BARBARA D CENTRAL INDEX KEY: 0001224778 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-12340 FILM NUMBER: 121236384 MAIL ADDRESS: STREET 1: C/O GREEN MOUNTAIN COFFEE ROASTERS INC 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 X0306 4 2012-11-30 0 0000909954 GREEN MOUNTAIN COFFEE ROASTERS INC GMCR 0001224778 CARLINI BARBARA D C/O GREEN MOUNTAIN COFFEE ROASTERS INC 33 COFFEE LANE WATERBURY VT 05676 1 0 0 0 GMCR Phantom Stock Units 2012-11-30 4 A 0 81.81 36.67 A 2012-11-30 GMCR Common Stock 81.81 28994 D 1 For 1 On 11/30/2012, Ms. Carlini acquired 81.81 units of Phantom Stock at a unit price of $36.67 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 2012-12-03