- Initial Statement of Beneficial Ownership (3)
17 Mars 2011 - 3:27PM
Edgar (US Regulatory)
FORM 3
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES
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OMB APPROVAL
OMB Number:
3235-0104
Expires:
February 28, 2011
Estimated average burden
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Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(h) of the Investment Company Act of 1940
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1. Name and Address of Reporting Person
*
CONWAY SHAWN
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2. Date of Event Requiring Statement (MM/DD/YYYY)
3/9/2011
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3. Issuer Name
and
Ticker or Trading Symbol
PEETS COFFEE & TEA INC [PEET]
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(Last)
(First)
(Middle)
C/O PEET'S COFFEE & TEA, INC., 1400 PARK AVENUE
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4. Relationship of Reporting Person(s) to Issuer (Check all applicable)
_____ Director
_____ 10% Owner
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X
___ Officer (give title below)
_____ Other (specify below)
VP, Chief Supply Chain Officer /
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(Street)
EMERYVILLE, CA 94608
(City)
(State)
(Zip)
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5. If Amendment, Date Original Filed
(MM/DD/YYYY)
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6. Individual or Joint/Group Filing
(Check Applicable Line)
_
X
_ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person
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Table I - Non-Derivative Securities Beneficially Owned
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1.Title of Security
(Instr. 4)
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2. Amount of Securities Beneficially Owned
(Instr. 4)
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3. Ownership Form: Direct (D) or Indirect (I)
(Instr. 5)
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4. Nature of Indirect Beneficial Ownership
(Instr. 5)
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Common Stock
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621
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D
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Table II - Derivative Securities Beneficially Owned (
e.g.
, puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security
(Instr. 4)
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2. Date Exercisable and Expiration Date
(MM/DD/YYYY)
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3. Title and Amount of Securities Underlying Derivative Security
(Instr. 4)
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4. Conversion or Exercise Price of Derivative Security
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5. Ownership Form of Derivative Security: Direct (D) or Indirect (I)
(Instr. 5)
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6. Nature of Indirect Beneficial Ownership
(Instr. 5)
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Date Exercisable
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Expiration Date
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Title
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Amount or Number of Shares
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Stock Option (Right to Buy)
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(1)
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1/14/2020
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Common Stock
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50000
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$33.57
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D
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Stock Option (Right to Buy)
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(2)
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4/14/2020
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Common Stock
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7500
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$39.51
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D
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Explanation of Responses:
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(
1)
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The option vests as to 20% of the shares on the one year anniversary of January 15, 2010 and in equal monthly installments thereafter over 4 years.
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(
2)
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The option vests as to 25% of the shares in equal annual installments over 4 years from April 15, 2010.
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Reporting Owners
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Reporting Owner Name / Address
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Relationships
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Director
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10% Owner
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Officer
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Other
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CONWAY SHAWN
C/O PEET'S COFFEE & TEA, INC.
1400 PARK AVENUE
EMERYVILLE, CA 94608
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VP, Chief Supply Chain Officer
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Signatures
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Shawn Conway, by /s/ Robin Riske, Attorney-in-Fact
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3/16/2011
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**
Signature of Reporting Person
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Date
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
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*
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If the form is filed by more than one reporting person,
see
Instruction 5(b)(v).
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**
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Intentional misstatements or omissions of facts constitute Federal Criminal Violations.
See
18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
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Note:
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File three copies of this Form, one of which must be manually signed. If space is insufficient,
see
Instruction 6 for procedure.
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Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB control number.
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