0001179110-15-015626.txt : 20151202
0001179110-15-015626.hdr.sgml : 20151202
20151202201145
ACCESSION NUMBER: 0001179110-15-015626
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: MILLER HINDA
CENTRAL INDEX KEY: 0001224775
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-12340
FILM NUMBER: 151266059
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
2015-11-30
0
0000909954
KEURIG GREEN MOUNTAIN, INC.
GMCR
0001224775
MILLER HINDA
33 COFFEE LANE
WATERBURY
VT
05676
1
0
0
0
Phantom Stock Units
2015-11-30
4
M
0
57
52.40
A
Common Stock
57
18934
D
Each Phantom Stock Unit is the economic equivalent of one share of Common Stock.
On 11/30/2015 the reporting person acquired 57 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