0001179110-15-014386.txt : 20151103 0001179110-15-014386.hdr.sgml : 20151103 20151103171506 ACCESSION NUMBER: 0001179110-15-014386 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20151031 FILED AS OF DATE: 20151103 DATE AS OF CHANGE: 20151103 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: MILLER HINDA CENTRAL INDEX KEY: 0001224775 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-12340 FILM NUMBER: 151194586 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 2015-10-31 0 0000909954 KEURIG GREEN MOUNTAIN, INC. GMCR 0001224775 MILLER HINDA 33 COFFEE LANE WATERBURY VT 05676 1 0 0 0 Phantom Stock Units 2015-10-31 4 M 0 59 50.75 A Common Stock 59 18877 D Each Phantom Stock Unit is the economic equivalent of one share of Common Stock. On 10/31/2015 the reporting person acquired 59 Phantom Stock Units at a unit price of $50.75 (the closing price of a share of Keurig Green Mountain, Inc.'s common stock on 10/30/2015, the last trading day of the month) as a result of a fee deferral. Distribution is made under the Keurig Green Mountain, Inc. Amended and Restated 2002 Deferred Compensation Plan, as amended, on a fixed date (or dates), or at the time of the participants death, disability, or termination of service. /s/ Jessica H. Collins, pursuant to a Power of Attorney 2015-11-03