0001225208-21-014246.txt : 20211201 0001225208-21-014246.hdr.sgml : 20211201 20211201124312 ACCESSION NUMBER: 0001225208-21-014246 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20211130 FILED AS OF DATE: 20211201 DATE AS OF CHANGE: 20211201 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: FLORNESS DANIEL L CENTRAL INDEX KEY: 0001017427 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-09225 FILM NUMBER: 211462126 MAIL ADDRESS: STREET 1: FASTENAL CO STREET 2: 2001 THEURER BLVD CITY: WINONA STATE: MN ZIP: 55987 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: FULLER H B CO CENTRAL INDEX KEY: 0000039368 STANDARD INDUSTRIAL CLASSIFICATION: ADHESIVES & SEALANTS [2891] IRS NUMBER: 410268370 STATE OF INCORPORATION: MN FISCAL YEAR END: 1127 BUSINESS ADDRESS: STREET 1: 1200 WILLOW LAKE BLVD CITY: ST PAUL STATE: MN ZIP: 55110-5132 BUSINESS PHONE: 6126453401 MAIL ADDRESS: STREET 1: 1200 WILLOW LAKE BLVD CITY: ST PAUL STATE: MN ZIP: 55110-5132 4 1 doc4.xml X0306 4 2021-11-30 0000039368 FULLER H B CO FUL 0001017427 FLORNESS DANIEL L 1200 WILLOW LAKE BOULEVARD P.O. BOX 64683 ST. PAUL MN 55164-0683 1 Common Stock 1351.0000 D Stock Units 0.0000 2021-11-30 4 A 0 300.7100 73.1600 A Common Stock 300.7100 14167.9700 D These units convert into shares of common stock on a 1-for-1 basis. These units will be converted into shares of common stock upon retirement, death, disability or certain specified events, all as defined in such plan, subject to holding periods required by law. This amount includes stock units acquired pursuant to a dividend equivalent feature of the Directors' Deferred Compensation Plan. /s/ Timothy J. Keenan, Attorney-in-Fact 2021-12-01