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 |
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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) |
LUNDQUIST NICHOLAS J | 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 | ||||||||||||||||||||||||||||
2001 THEURER BOULEVARD | |||||||||||||||||||||||||||||
(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 | 2/27/2019 | P | 4 | A | $62.53 | 526 | I | Owned by | |||||||||||||||||||||
father (4) | |||||||||||||||||||||||||||||
Common Stock | 5/22/2019 | P | 4 | A | $64.85 | 1060 | I | Owned by | |||||||||||||||||||||
father (4) | |||||||||||||||||||||||||||||
Common Stock | 8/22/2019 | P | 7 | A | $30.99 | 1067 | I | Owned by | |||||||||||||||||||||
father (4) | |||||||||||||||||||||||||||||
Common Stock | 11/22/2019 | P | 7 | A | $35.34 | 1074 | I | Owned by | |||||||||||||||||||||
father (4) | |||||||||||||||||||||||||||||
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:
- Shares acquired in connection with a dividend reinvestment program.
- On May 22, 2019, the common stock of Fastenal Company split 2-for-1 resulting in the reporting person's father acquiring an additional 530 shares in this account.
- The holdings report filed on 4/29/2019 did not reflect an additional 10 shares maintained within this account acquired in prior years in connection with a dividend reinvestment program.
- Shares are owned by reporting person's father and reporting person, along with his siblings, maintain a power of attorney to share investment and voting power over these shares. Reporting person disclaims beneficial ownership or these shares, and the filing of this report is not an admission that the reporting person is the beneficial owner of these securities for purposes of Section 16 or any other purpose.
Reporting Owners
Reporting Owner Name / Address | Relationships |
Director 10% Owner OfficerOther |
LUNDQUIST NICHOLAS J
2001 THEURER BOULEVARD X WINONA, MN 55987
Signatures
/s/ John Milek, Attorney-in-Fact | 2/7/2020 | |
**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.
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Fastenal Company published this content on 07 February 2020 and is solely responsible for the information contained therein. Distributed by Public, unedited and unaltered, on 07 February 2020 20:52:00 UTC