SEC Form 5
FORM 5 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

ANNUAL STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP

Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934
or Section 30(h) of the Investment Company Act of 1940
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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.
1. Name and Address of Reporting Person*
OBERTON WILLARD D

(Last) (First) (Middle)
2001 THEURER BOULEVARD

(Street)
WINONA MN 55987

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
FASTENAL CO [ FAST ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director 10% Owner
X Officer (give title below) Other (specify below)
CEO
3. Statement for Issuer's Fiscal Year Ended (Month/Day/Year)
12/31/2012
4. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
X Form filed by One Reporting Person
Form filed by More than One Reporting Person
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
1. Title of Security (Instr. 3) 2. Transaction Date (Month/Day/Year) 2A. Deemed Execution Date, if any (Month/Day/Year) 3. Transaction Code (Instr. 8) 4. Securities Acquired (A) or Disposed Of (D) (Instr. 3, 4 and 5) 5. Amount of Securities Beneficially Owned at end of Issuer's Fiscal Year (Instr. 3 and 4) 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 7. Nature of Indirect Beneficial Ownership (Instr. 4)
Amount (A) or (D) Price
Common Stock 12/31/2001 G5 80 (1) D $0 117,440 (1) D
Common Stock 04/30/2009 (2) G 6,399 (2) D $0 224,839 (2) D
Common Stock 01/25/2012 G 1,800 D $0 503,249 D
Common Stock 04/20/2012 G 1,000 D $0 502,249 D
Common Stock 12/26/2012 G 112,500 D $0 389,749 D
Common Stock 12/26/2012 G 7,500 D $0 129,412 (3) I Owned by Spouse
Common Stock 653 (4) I Held by 401(K) Plan
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 3) 2. Conversion or Exercise Price of Derivative Security 3. Transaction Date (Month/Day/Year) 3A. Deemed Execution Date, if any (Month/Day/Year) 4. Transaction Code (Instr. 8) 5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) 6. Date Exercisable and Expiration Date (Month/Day/Year) 7. Title and Amount of Securities Underlying Derivative Security (Instr. 3 and 4) 8. Price of Derivative Security (Instr. 5) 9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) 10. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 11. Nature of Indirect Beneficial Ownership (Instr. 4)
(A) (D) Date Exercisable Expiration Date Title Amount or Number of Shares
Explanation of Responses:
1. The amounts reflect securities held as of 12/31/2001. The 80 shares gifted in 2001 have been incorrectly included in subsequent reports filed by the reporting person since the date of the gift and such reported shares were split in 2002, 2005 and 2011, resulting in 640 shares over-reported by the reporting person as of the end of fiscal year 2012.
2. Amendment to a Form 5 filed for the reporting person on 2/04/2010. The amounts reflect security amounts as of 12/31/2009. The Form 5 filed on 2/04/2010 reporting the transaction on 4/30/2009 inaccurately stated the gift amount as 6400 shares, as opposed to 6399 shares.
3. Reporting person disclaims beneficial ownership of these shares.
4. Shares attributed to reporting person's account within issuer's 401(K) Plan as of 12/31/2012.
/s/ John Milek, Attorney-in-Fact 02/01/2013
** 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).
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