SEC Form 5 · accession 0001179110-17-003976
ROSS STORES, INC. · ROST
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
James S Fassio
Officer — President, Chief Dev. Officer
Period of report
Jan 28, 2017
Accepted (ET)
Mar 6, 2017 · 4:08 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 | Nature of ownership |
|---|---|---|---|---|---|---|---|---|
| Common StockF1 | Sep 30, 2016 | G | 110 | $0.00 | D | 219,101 | D | |
| Common StockF1 | Dec 30, 2016 | G | 97 | $0.00 | D | 219,101 | D | |
| Common StockF2 | Sep 30, 2016 | G | 110 | $0.00 | A | 519,516 | I | by Trust A |
| Common StockF2 | Oct 5, 2016 | G | 5,000 | $0.00 | D | 514,516 | I | by Trust A |
| Common StockF2 | Dec 30, 2016 | G | 97 | $0.00 | A | 514,613 | I | by Trust A |
| Common StockF4 | holding | — | — | — | 86,930 | I | by Trust B |
Table II — derivative securities
No Table II lines on this filing.
Explanation of responses
- F1Securities Beneficially Owned includes shares acquired pursuant to issuer's employee stock purchase plan in a transaction exempt under Rule 16b-3.
- F2Securities held in the name of James S. Fassio Revocable Trust.
- F3Bona Fide Gift
- F4Securities held in the name of James S. Fassio 2012 Dynasty Irrevocable Trust.