SEC Form 5 · accession 0001179110-15-015809

ROSS STORES, INC. · ROST

Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗

Reporting owner

Barbara Rentler

Officer — Chief Executive Officer · Director

Period of report

Jan 31, 2015

Accepted (ET)

Dec 4, 2015 · 4:02 pm EST

Rule 10b5-1 plan

unknown — predates the checkbox

Issuer CIK

0000745732

Table I — non-derivative securities

Security	Date	Code	Shares	Price	A/D	Owned after	D/I
Common Stock^F4,F5	Apr 2, 2001	P	52	$4.7655	A	354,445	D
Common Stock^F4,F6	Jul 2, 2001	P	40	$6.165	A	354,485	D
Common Stock^F4,F7	Oct 1, 2001	P	34	$7.5125	A	354,519	D
Common Stock^F4,F8	Jan 2, 2002	P	38	$8.1675	A	354,557	D
Common Stock^F4,F9	Apr 1, 2002	P	39	$9.0125	A	354,596	D
Common Stock^F4,F10	Jul 1, 2002	P	35	$10.035	A	354,631	D
Common Stock^F4,F6	Oct 1, 2002	P	40	$8.8125	A	354,671	D
Common Stock^F4,F11	Jan 2, 2003	P	33	$10.8075	A	354,704	D
Common Stock^F4,F12	Apr 1, 2003	P	47	$9.125	A	354,751	D
Common Stock^F4,F9	Jul 1, 2003	P	39	$10.7525	A	354,790	D
Common Stock^F4,F13,F14	Oct 1, 2003	P	36	$12.06	A	354,826	D
Common Stock^F1,F2	holding	—	—		—	354,393	D

Table II — derivative securities

No Table II lines on this filing.

Explanation of responses

F1The amount shown has been corrected to include an additional 215 shares that are held by the reporting person at the end of the latest fiscal year (FYE January 31, 2015) and that were inadvertently omitted from the Form 3 filed on 3/22/2001. The underlying shares were beneficially and directly owned at the time the reporting person became an officer for purposes of reporting under Sec. 16(a). Subsequent to the original Form 3 filing date and through January 31, 2015, there have been two stock splits. Each split was 2:1. The original (pre-split) number of additional shares of common stock beneficially owned and that should have been reported in the Form 3 was 53.75. The amount shown is the resulting number of shares held at the end of the latest fiscal year, taking into account such additional shares and all other transactions by the reporting person through January 31, 2015, other than the additional transactions reported below on this Form 5.
F10The original (pre-split) number of additional shares of common stock acquired was 8.75.
F11The original (pre-split) number of additional shares of common stock acquired was 8.25.
F12The original (pre-split) number of additional shares of common stock acquired was 11.75.
F13The original (pre-split) number of additional shares of common stock acquired was 9.
F14Amounts of securities beneficially owned as reported in this Form 5 are as of the end of the latest fiscal year (FYE January 31, 2015). They are not adjusted to reflect the 2:1 stock split (in the form of a 100 percent stock dividend) paid on June 11, 2015 to stockholders of record as of April 22, 2015.
F2Securities Beneficially Owned includes 245 shares acquired during the prior fiscal year pursuant to issuer's employee stock purchase plan in a transaction exempt under Rule 16b-3.
F3This resulted in a matching transaction with a nominal short swing profit, which has been paid over to the Company.
F4Amount shown is the resulting number of shares held at the end of the latest fiscal year (FYE January 31, 2015). The underlying shares were beneficially acquired on the transaction date shown in column 2, as a result of purchases under a broker-administered dividend reinvestment program. Subsequent to the original acquisition date and through January 31, 2015, there have been two stock splits (each paid in the form of a stock dividend). Each split was 2:1.
F5The original (pre-split) number of additional shares of common stock acquired was 13.
F6The original (pre-split) number of additional shares of common stock acquired was 10.
F7The original (pre-split) number of additional shares of common stock acquired was 8.5.
F8The original (pre-split) number of additional shares of common stock acquired was 9.5
F9The original (pre-split) number of additional shares of common stock acquired was 9.75.