0001179110-16-016939.txt : 20160104
0001179110-16-016939.hdr.sgml : 20160104
20160104171104
ACCESSION NUMBER: 0001179110-16-016939
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20151231
FILED AS OF DATE: 20160104
DATE AS OF CHANGE: 20160104
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: 161319060
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
2015-12-31
0
0000909954
KEURIG GREEN MOUNTAIN, INC.
GMCR
0001209446
HAYES JOHN D
33 COFFEE LANE
WATERBURY
VT
05676
1
0
0
0
Phantom Stock Units
2015-12-31
4
M
0
347
89.98
A
Common Stock
347
2594
D
Each Phantom Stock Unit is the economic equivalent of one share of Common Stock.
On 12/31/2015 the reporting person acquired 347 Phantom Stock Units at a unit price of $89.98 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
2016-01-04