SEC Form 4 · accession 0001179110-16-017270
KEURIG GREEN MOUNTAIN, INC. · GMCR
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Hinda Miller
Director
Period of report
Jan 1, 2016
Accepted (ET)
Jan 5, 2016 · 8:23 pm EST
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0000909954
Table I — non-derivative securities
| Security | Date | Code | Shares | Price | A/D | Owned after | D/I | Nature of ownership |
|---|---|---|---|---|---|---|---|---|
| Common StockF1 | Jan 1, 2016 | M | 12,552 | $0.00 | A | 68,035 | D | |
| Common Stock | holding | — | — | — | 17,500 | I | 2014 Grantor Retained Annuity | |
| Common Stock | holding | — | — | — | 16,930 | I | 2015 Grantor Retained Annuity |
Table II — derivative securities
| Security | Conv. / exercise price | Date | Code | Shares | A/D | Exercisable | Expires | Underlying | Underlying shares | Owned after | D/I |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Phantom Stock UnitsF1,F2 | — | Jan 1, 2016 | M | 12,552 | D | — | — | Common Stock | 12,552 | 6,814 | D |
Explanation of responses
- F1Each Phantom Stock Unit is the economic equivalent of one share of Common Stock.
- F2The Phantom Stock Units were granted under the Company's Amended and Restated 2002 Deferred Compensation Plan, as amended. This Form 4 is being filed to report the settlement of 12,552 Phantom Stock Units for shares of Common Stock pursuant to the reporting person's election to defer.