SEC Form 5 · accession 0001179110-16-018033
FASTENAL CO · FAST
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Gary A. Polipnick
Officer — Executive Vice President
Period of report
Dec 31, 2015
Accepted (ET)
Jan 27, 2016 · 4:59 pm EST
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0000815556
Table I — non-derivative securities
| Security | Date | Code | Shares | Price | A/D | Owned after | D/I | Nature of ownership |
|---|---|---|---|---|---|---|---|---|
| Common StockF1 | Dec 31, 2015 | L | 17 | $40.00 | A | 59,324 | D | |
| Common StockF3 | Dec 31, 2015 | Z | 1,672 | $0.00 | D | 0 | I | By Trust |
| Common StockF2 | holding | — | — | — | 1,735 | D | ||
| Common Stock | holding | — | — | — | 1,862 | I | Held in custodian account for Daughter | |
| Common StockF5 | holding | — | — | — | 963 | I | Held in custodian account for Daughter | |
| Common Stock | holding | — | — | — | 898 | I | Held by Spouse | |
| Common StockF4 | holding | — | — | — | 6,838 | I | Held in 401(K) Plan |
Table II — derivative securities
No Table II lines on this filing.
Explanation of responses
- F1Shares acquired in connection with a dividend reinvestment program.
- F2Shares maintained in self-directed IRA.
- F3Reporting person's spouse served as a Trustee of a Trust for the benefit of the spouse's sibling and the Trust was dissolved on December 31, 2015, whereby the shares held in the Trust transferred to spouse's sibling on this date.
- F4Shares attributed to reporting person's account within issuer's 401(K) Plan as of December 31, 2015.
- F5Reporting person disclaims beneficial ownership of these shares.