0001181431-11-060740.txt : 20111216 0001181431-11-060740.hdr.sgml : 20111216 20111216092132 ACCESSION NUMBER: 0001181431-11-060740 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20111214 FILED AS OF DATE: 20111216 DATE AS OF CHANGE: 20111216 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Primo Water Corp CENTRAL INDEX KEY: 0001365101 STANDARD INDUSTRIAL CLASSIFICATION: WHOLESALE-GROCERIES & GENERAL LINE [5141] IRS NUMBER: 300278688 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 104 CAMBRIDGE PLAZA DRIVE CITY: Winston Salem STATE: NC ZIP: 27104 BUSINESS PHONE: 336-331-4000 MAIL ADDRESS: STREET 1: 104 CAMBRIDGE PLAZA DRIVE CITY: Winston Salem STATE: NC ZIP: 27104 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: PRIM BILLY D CENTRAL INDEX KEY: 0001078296 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-34850 FILM NUMBER: 111264951 MAIL ADDRESS: STREET 1: 104 CAMBRIDGE PLAZA DRIVE CITY: WINSTON SALEM STATE: NC ZIP: 27104 4 1 rrd328327.xml PRIM FORM 4 X0304 4 2011-12-14 0 0001365101 Primo Water Corp PRMW 0001078296 PRIM BILLY D 104 CAMBRIDGE PLAZA DRIVE WINSTON-SALEM NC 27104 1 1 1 0 Chairman, CEO and President Common Stock 2011-12-14 4 P 0 20000 2.99 A 2297056 D Common Stock 8032 I See Footnote Common Stock 4791 I See Footnote Common Stock 4791 I See Footnote Common Stock 23957 I See Footnote Common Stock 23957 I See Footnote Common Stock 4791 I See Footnote Common Stock 4791 I See Footnote 20,000 of these shares are restricted stock units which may only be settled in stock and which vest in equal annual installments on March 29 of each of 2012, 2013 and 2014. Held by Mr. Prim's spouse. Held by Billy D. Prim Revocable Trust of which Mr. Prim is the sole trustee. Held by BD Prim, LLC of which Mr. Prim is the sole manager. Held by 2010 Irrevocable Trust fbo Sarcanda Westmoreland Bellisimo of which Mr. Prim is the sole trustee. Held by 2010 Irrevocable Trust fbo Anthony Gray Westmoreland of which Mr. Prim is the sole trustee. Held by 2010 Irrevocable Trust fbo Jager Grayln Dean Bellisimo of which Mr. Prim is the sole trustee. Held by 2010 Irrevocable Trust fbo Joseph Alexander Bellisimo of which Mr. Prim is the sole trustee. /s/ Patrick J. Rogers by power of attorney for Billy D. Prim 2011-12-16