FORM 3 |
UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 INITIAL STATEMENT OF 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 |
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1. Name and Address of Reporting Person*
(Street)
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2. Date of Event Requiring Statement
(Month/Day/Year) 07/23/2012 |
3. Issuer Name and Ticker or Trading Symbol
FASTENAL CO [ FAST ] |
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4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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5. If Amendment, Date of Original Filed
(Month/Day/Year) |
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6. Individual or Joint/Group Filing (Check Applicable Line)
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Table I - Non-Derivative Securities Beneficially Owned | |||
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1. Title of Security (Instr. 4) | 2. Amount of Securities Beneficially Owned (Instr. 4) | 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) | 4. Nature of Indirect Beneficial Ownership (Instr. 5) |
Common Stock | 54,072(1) | D | |
Common Stock | 1,728(2) | D | |
Common Stock | 895(2)(3) | I | Held by Spouse |
Common Stock | 2,468(3) | I | Held by Daughter |
Common Stock | 1,789(3) | I | Held in custodian account for Daughter |
Common Stock | 893(3) | I | Held in custodian account for Daughter |
Common Stock | 2,661(3) | I | By Trust(4) |
Common Stock | 3,033(7) | I | Held in 401(K) Plan |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||
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1. Title of Derivative Security (Instr. 4) | 2. Date Exercisable and Expiration Date (Month/Day/Year) | 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) | 4. Conversion or Exercise Price of Derivative Security | 5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) | 6. Nature of Indirect Beneficial Ownership (Instr. 5) | ||
Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||
Employee Stock Option (Right to Buy) | (5) | 05/31/2016 | Common Stock | 10,000 | $22.5 | D | |
Employee Stock Option (Right to Buy) | (5) | 05/31/2018 | Common Stock | 30,000 | $27 | D | |
Employee Stock Option (Right to Buy) | (6) | 05/31/2021 | Common Stock | 2,500 | $54 | D |
Explanation of Responses: |
1. Shares held jointly by reporting person and his spouse. |
2. Shares maintained in a self-directed IRA. |
3. Reporting person disclaims beneficial ownership of these shares. |
4. Reporting person's spouse serves as a Trustee of a Trust maintained for the benefit of spouse's sibling. |
5. This option will vest and become exercisable over a period of eight years, with 50% of the option vesting and becoming exercisable half way through the relevant vesting period and the remainder vesting and becoming exercisable proportionately on each anniversary of the date of grant of the option occuring after the initial 50% vesting date. |
6. This option will vest and become exercisable over a period of five years, with 50% of the option vesting and becoming exercisable half way through the relevant vesting period and the remainder vesting and becoming exercisable incrementally (20%,20% and 10% respectively) on each anniversary of the date of grant of the option occuring after the initial 50% vesting date. |
7. Shares attributed to reporting person's account within issuer's 401(K) Plan as of June 30, 2012. |
/s/ John J. Milek, Attorney-in-Fact | 07/30/2012 | |
** 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 5 (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 Number. |