SEC Form 4 · accession 0001179110-16-018660
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
Feb 4, 2016
Accepted (ET)
Feb 5, 2016 · 4:56 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 Stock | Feb 4, 2016 | M | 10,000 | $22.50 | A | 69,324 | D | |
| Common Stock | Feb 4, 2016 | S | 10,000 | $43.54 | D | 59,324 | D | |
| Common Stock | holding | — | — | — | 1,735 | D | ||
| Common StockF3 | holding | — | — | — | 1,862 | I | Held in custodian account for Daughter | |
| Common StockF3 | holding | — | — | — | 963 | I | Held in custodian account for Daughter | |
| Common Stock | holding | — | — | — | 898 | I | Held by Spouse | |
| Common StockF4 | holding | — | — | — | 6,965 | I | Held in 401(K) Plan |
Table II — derivative securities
| Security | Conv. / exercise price | Date | Code | Shares | A/D | Exercisable | Expires | Underlying | Underlying shares | Owned after | D/I |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Employee Stock Option (Right to Buy)F1 | $22.50 | Feb 4, 2016 | M | 10,000 | D | — | May 31, 2016 | Common Stock | 10,000 | 0 | D |
| Employee Stock Option (Right to Buy)F1 | $27.00 | holding | — | — | — | — | May 31, 2018 | Common Stock | 30,000 | 30,000 | D |
| Employee Stock Option (Right to Buy)F2 | $54.00 | holding | — | — | — | — | May 31, 2021 | Common Stock | 2,500 | 2,500 | D |
| Employee Stock Option (Right to Buy)F2 | $56.00 | holding | — | — | — | — | May 31, 2023 | Common Stock | 80,000 | 80,000 | D |
| Employee Stock Option (Right to Buy)F2 | $42.00 | holding | — | — | — | — | May 31, 2024 | Common Stock | 10,714 | 10,714 | D |
Explanation of responses
- F1The options will fully vest and become exercisable over a period of eight years, with 50% of the options vesting and becoming exercisable half way through the relevant vesting period, and the remainder vesting and becoming exercisable proportionately each year thereafter.
- F2The options will fully vest and become exercisable over a period of five years, with 50% of the options vesting and becoming exercisable half way through the relevant vesting period, and the remainder vesting and becoming exercisable incrementally (20%, 20% and 10%) each year thereafter.
- F3Reporting person disclaims beneficial ownership of these shares.
- F4Shares attributed to reporting person's account within issuer's 401(K) Plan as of February 4, 2016.