0001179110-15-015625.txt : 20151202 0001179110-15-015625.hdr.sgml : 20151202 20151202201057 ACCESSION NUMBER: 0001179110-15-015625 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20151130 FILED AS OF DATE: 20151202 DATE AS OF CHANGE: 20151202 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: HAYES JOHN D CENTRAL INDEX KEY: 0001209446 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-12340 FILM NUMBER: 151266058 MAIL ADDRESS: STREET 1: AMERICAN EXPRESS COMPANY STREET 2: 200 VESEY STREET CITY: NEW YORK STATE: NY ZIP: 10285 4 1 edgar.xml FORM 4 - X0306 4 2015-11-30 0 0000909954 KEURIG GREEN MOUNTAIN, INC. GMCR 0001209446 HAYES JOHN D 33 COFFEE LANE WATERBURY VT 05676 1 0 0 0 Phantom Stock Units 2015-11-30 4 M 0 38 52.40 A Common Stock 38 2239 D Each Phantom Stock Unit is the economic equivalent of one share of Common Stock. On 11/30/2015 the reporting person acquired 38 Phantom Stock Units at a unit price of $52.40 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 2015-12-02