0001179110-15-001612.txt : 20150203
0001179110-15-001612.hdr.sgml : 20150203
20150203174435
ACCESSION NUMBER: 0001179110-15-001612
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 2
CONFORMED PERIOD OF REPORT: 20150130
FILED AS OF DATE: 20150203
DATE AS OF CHANGE: 20150203
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: WESLEY NORMAN H
CENTRAL INDEX KEY: 0001190600
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-12340
FILM NUMBER: 15572607
MAIL ADDRESS:
STREET 1: 225 W WESTMINSTER
CITY: LAKE FOREST
STATE: IL
ZIP: 60045
4
1
edgar.xml
FORM 4 -
X0306
4
2015-01-30
0
0000909954
KEURIG GREEN MOUNTAIN, INC.
GMCR
0001190600
WESLEY NORMAN H
33 COFFEE LANE
WATERBURY
VT
05676
1
0
0
0
Phantom Stock Units
2015-01-30
4
M
0
979
122.56
A
2015-01-30
Common Stock
979
2972
D
Each share of Phantom Stock Units is the economic equivalent of one share of Common Stock.
On 1/30/2015 the reporting person acquired 979 units of Phantom Stock at a unit price of $122.56 as a result of a deferral of restricted stock units granted to him on 1/30/2015. The restricted stock units fully vested on the date of grant.
Distribution is made under the Keurig Green Mountain 2002 Deferred Compensation Plan, as amended, on a fixed date, or at the time of the participants death, disability, or termination of service.
/s/ Jessica H. Collins, pursuant to a Power of Attorney
2015-02-03
EX-24
2
ex24wesley20150129.txt
LIMITED POWER OF ATTORNEY
Know all by these present, that the undersigned hereby constitutes
and appoints each of Michael J. Degnan, Jessica H. Collins and Kristin
E. Blazewicz, or any of them acting singly and with full power of
substitution, the undersigned's true and lawful attorney-in-fact
to:
execute for and on behalf of the undersigned, in the undersigned's
capacity as an officer or director or both of Keurig Green Mountain,
Inc. (the "Company"), (a) Forms 3, 4 and 5 (and any amendments thereto)
in accordance with Section 16(a) of the Securities Exchange Act of 1934,
as amended (the "Exchange Act"), and the rules thereunder, (b) Schedule
13D; and (c) notices on Form 144 in furtherance of the undersigned's
obligations, if any, under Rule 144 under the Securities Act of 1933,
as amended (the "Securities Act"), with respect to Company securities;
do and perform any and all acts for and on behalf of the
undersigned which may be necessary or desirable to complete and
execute any such Form 3, 4 or 5, Schedule 13D, or Form 144,
complete and execute any amendments thereto, and timely file such
form with the U.S. Securities and Exchange Commission (the "SEC")
and any securities exchange or similar authority, including
without limitation the filing of a Form ID or any other documents
necessary or appropriate to enable the undersigned to file the
Forms 3, 4 and 5 electronically with the SEC;
seek or obtain, as the undersigned's representative and on the
undersigned's behalf, information on transactions in the Company's
securities from any third party, including brokers, employee
benefit plan administrators and trustees, and the undersigned
hereby authorizes any such person to release any such information
to each of the undersigned's attorneys-in-fact appointed by this
Limited Power of Attorney and approves and ratifies any such
release of information; and
take any other action in connection with the foregoing which, in
the opinion of such attorney-in-fact, may be of benefit to, in the
best interest of, or legally required by or for, the undersigned,
it being understood that the documents executed by such attorney-
in-fact on behalf of the undersigned pursuant to this Limited
Power of Attorney shall be in such form and shall contain such
information and disclosure as such attorney-in-fact may approve in
such attorney-in-fact's discretion.
The undersigned hereby grants to each such attorney-in-fact full
power and authority to do and perform any and every act and thing
whatsoever required, necessary or proper to be done in the
exercise of any of the rights and powers herein granted, as fully
to all intents and purposes as the undersigned might or could do
if personally present, with full power of substitution or
revocation, hereby ratifying and confirming all that such
attorney-in-fact, or such attorney-in-fact's substitute or
substitutes, shall lawfully do or cause to be done by virtue of
this Limited Power of Attorney and the rights and powers herein
granted.
The undersigned acknowledges that the foregoing attorneys-in-fact,
in serving in such capacity at the request and on the behalf of
the undersigned, are not assuming, nor is the Company assuming,
any of the undersigned's responsibilities to comply with, or any
liability for the failure to comply with, any provision of Section
16 or Rule 13d of the Exchange Act or the rules promulgated
thereunder or Rule 144 of the Securities Act or the rules
promulgated thereunder.
This Limited Power of Attorney shall remain in full force and
effect until the undersigned is no longer required to file Forms
3, 4 or 5 with respect to the undersigned's holdings of and
transactions in securities issued by the Company, unless earlier
revoked by the undersigned in a signed writing delivered to each
of the foregoing attorneys-in-fact.
IN WITNESS WHEREOF, the undersigned has executed this Limited
Power of Attorney as of this 29th day of January, 2015.
Signed and acknowledged:
/s/ Norman H. Wesley
Signature