FORM 5
[ ] Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b). [ ] Form 3 Holdings Reported
[ ] Form 4 Transactions Reported
UNITED STATES SECURITIES AND EXCHANGE COMMISSION | OMB APPROVAL |
OMB Number: 3235-0362 | |
Washington, D.C. 20549 | Estimated average burden |
hours per response... 1.0 |
ANNUAL STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP
OF SECURITIES
Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 or
Section 30(h) of the Investment Company Act of 1940
1. Name and Address of Reporting Person * | 2. Issuer Name and Ticker or Trading Symbol | 5. Relationship of Reporting Person(s) to Issuer |
(Check all applicable) |
OBERTON WILLARD D | FASTENAL CO [FAST] | __X__ Director | _____ 10% Owner | ||||||||||||||||||||||||
(Last) | (First) | (Middle) | 3. Statement for Issuer's Fiscal Year Ended | ||||||||||||||||||||||||
_____ Officer (give title below) | _____ Other (specify below) | ||||||||||||||||||||||||||
(MM/DD/YYYY) | 12/31/2019 | ||||||||||||||||||||||||||
23959 BLACKBERRY ROAD | |||||||||||||||||||||||||||
(Street) | 4. If Amendment, Date Original Filed(MM/DD/YYYY) | 6. Individual or Joint/Group Filing(Check Applicable Line) | |||||||||||||||||||||||||
WINONA, MN 55987 | _X_ Form Filed by One Reporting Person | ||||||||||||||||||||||||||
(City) | (State) | (Zip) | ___ Form Filed by More than One Reporting Person | ||||||||||||||||||||||||
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned | |||||||||||||||||||||||||||
1.Title of Security | 2. Trans. Date | 2A. Deemed | 3. Trans. Code | 4. Securities Acquired (A) | 5. Amount of Securities Beneficially Owned | 6. | 7. Nature | ||||||||||||||||||||
(Instr. 3) | Execution | (Instr. 8) | or Disposed of (D) | Following Reported Transaction(s) | Ownership | of Indirect | |||||||||||||||||||||
Date, if any | (Instr. 3, 4 and 5) | (Instr. 3 and 4) | Form: | Beneficial | |||||||||||||||||||||||
Direct (D) | Ownership | ||||||||||||||||||||||||||
or Indirect | (Instr. 4) | ||||||||||||||||||||||||||
(A) or | (I) | ||||||||||||||||||||||||||
Amount | (D) | Price | (Instr. 4) | ||||||||||||||||||||||||
Common Stock | 5/1/2019 | G | 12000 (1) | D | $0 | 933018 | I | By family | |||||||||||||||||||
trust | |||||||||||||||||||||||||||
Common Stock | 6/5/2019 | G | 3325 | D | $0 | 929693 | I | By family | |||||||||||||||||||
trust | |||||||||||||||||||||||||||
Common Stock | 11/27/2019 | G | 2000 | D | $0 | 927693 | I | By family | |||||||||||||||||||
trust | |||||||||||||||||||||||||||
Common Stock | 12/3/2019 | G | 3250 | D | $0 | 924443 | I | By family | |||||||||||||||||||
trust | |||||||||||||||||||||||||||
Common Stock | 12/4/2019 | G | 1500 | D | $0 | 922943 | I | By family | |||||||||||||||||||
trust | |||||||||||||||||||||||||||
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||||||||||||||||||||||
1. Title of Derivate | 2. Conversion | 3. Trans. | 3A. Deemed | 4. Trans. | 5. Number of | 6. Date Exercisable and | 7. Title and Amount of | 8. Price of | 9. Number | 10. | 11. Nature | ||||||||||||||||
Security | or Exercise | Date | Execution | Code | Derivative Securities | Expiration Date | Securities Underlying | Derivative | of | Ownership | of Indirect | ||||||||||||||||
(Instr. 3) | Price of | Date, if any | (Instr. 8) | Acquired (A) or | (MM/DD/YYYY) | Derivative Security | Security | Derivative | Form of | Beneficial | |||||||||||||||||
Derivative | Disposed of (D) | (Instr. 3 and 4) | (Instr. 5) | Securities | Derivative | Ownership | |||||||||||||||||||||
Security | (Instr. 3, 4 and 5) | Beneficially | Security: | (Instr. 4) | |||||||||||||||||||||||
Owned at | Direct (D) | ||||||||||||||||||||||||||
Date | Expiration | Amount or Number of | End of | or Indirect | |||||||||||||||||||||||
Title | Issuer's | (I) | |||||||||||||||||||||||||
Exercisable | Date | Shares | Fiscal Year | (Instr. 4) | |||||||||||||||||||||||
(A) | (D) | (Instr. 4) |
Explanation of Responses:
- A gift of 6,000 shares occurred on 5/1/2019, but the amount reported is adjusted (12,000 shares) to represent a 2-for-1 stock split on May 22, 2019.
Reporting Owners
Reporting Owner Name / Address | Relationships | |||||
Director | 10% Owner | OfficerOther | ||||
OBERTON WILLARD D | ||||||
23959 BLACKBERRY ROAD | X | |||||
WINONA, MN 55987 | ||||||
Signatures | ||||||
/s/ John Milek, Attorney-in-Fact | 2/4/2020 | |||||
**Signature of Reporting Person | Date |
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
- If the form is filed by more than one reporting person, see Instruction 4(b)(v).
-
Intentional misstatements or omissions of facts constitute Federal Criminal Violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure.
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB control number.
Attachments
- Original document
- Permalink
Disclaimer
Fastenal Company published this content on 04 February 2020 and is solely responsible for the information contained therein. Distributed by Public, unedited and unaltered, on 04 February 2020 16:53:01 UTC