0001179110-15-000207.txt : 20150105 0001179110-15-000207.hdr.sgml : 20150105 20150105163545 ACCESSION NUMBER: 0001179110-15-000207 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20150101 FILED AS OF DATE: 20150105 DATE AS OF CHANGE: 20150105 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: KEURIG GREEN MOUNTAIN, 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 ROASTERS INC DATE OF NAME CHANGE: 20030221 FORMER COMPANY: FORMER CONFORMED NAME: GREEN MOUNTAIN COFFEE INC DATE OF NAME CHANGE: 19930729 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: 15505465 MAIL ADDRESS: STREET 1: C/O GREEN MOUNTAIN COFFEE ROASTERS INC STREET 2: 33 COFFEE LANE CITY: WATERBURY STATE: VT ZIP: 05676 4 1 edgar.xml FORM 4 - X0306 4 2015-01-01 0 0000909954 KEURIG GREEN MOUNTAIN, INC. GMCR 0001224778 CARLINI BARBARA D 33 COFFEE LANE WATERBURY VT 05676 1 0 0 0 Common Stock 2015-01-01 4 M 0 3467 0 A 19142 D Phantom Stock Units 2015-01-01 4 M 0 3467 0 D Common Stock 3467 27389 D Each Phantom Stock Unit is the economic equivalent of one share of Common Stock. The Phantom Stock Units were granted under the Company's 2002 Deferred Compensation Plan, as amended. This Form 4 is being filed to report the settlement of 3,467 Phantom Stock Units for shares of Common Stock pursuant to the reporting person's election to defer. /s/ Kristin E. Blazewicz, pursuant to a Power of Attorney 2015-01-05