0001179110-12-016583.txt : 20121128 0001179110-12-016583.hdr.sgml : 20121128 20121128172807 ACCESSION NUMBER: 0001179110-12-016583 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20121126 FILED AS OF DATE: 20121128 DATE AS OF CHANGE: 20121128 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: FASTENAL CO CENTRAL INDEX KEY: 0000815556 STANDARD INDUSTRIAL CLASSIFICATION: RETAIL-BUILDING MATERIALS, HARDWARE, GARDEN SUPPLY [5200] IRS NUMBER: 410948415 STATE OF INCORPORATION: MN FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 2001 THEURER BLVD CITY: WINONA STATE: MN ZIP: 55987 BUSINESS PHONE: 5074545374 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Polipnick Gary A. CENTRAL INDEX KEY: 0001555049 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-16125 FILM NUMBER: 121229850 MAIL ADDRESS: STREET 1: 2413 ADVANCE ROAD CITY: MADISON STATE: WI ZIP: 53718 4 1 edgar.xml FORM 4 - X0306 4 2012-11-26 0 0000815556 FASTENAL CO FAST 0001555049 Polipnick Gary A. 2413 ADVANCE ROAD MADISON WI 53718 0 1 0 0 Executive Vice President Common Stock 2012-11-26 4 P 0 1000 40.50 A 3672 I By Trust Common Stock 54307 D Common Stock 1735 D Common Stock 898 I Held by Spouse Common Stock 2478 I Held by Daughter Common Stock 1796 I Held in custodian account for Daughter Common Stock 896 I Held in custodian account for Daughter Common Stock 3046 I Held in 401(K) Plan Reporting person's spouse serves as a Trustee of a Trust for the benefit of spouse's sibling. Shares maintained in a self-directed IRA. Reporting person disclaims beneficial ownership of these shares. Shares attributed to reporting person's account within issuer's 401(K) Plan as of September 30, 2012. /s/ John J. Milek, Attorney-in-Fact 2012-11-28