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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OMB Number: 3235-0362
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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*
HOLLIS MARK CLAYTON

(Last) (First) (Middle)
P.O. BOX 407

(Street)
LAKELAND FL 33802-0407

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
PUBLIX SUPER MARKETS INC [ NONE ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director 10% Owner
X Officer (give title below) Other (specify below)
Vice President
3. Statement for Issuer's Fiscal Year Ended (Month/Day/Year)
12/28/2012
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 01/16/2012 G 1,286 A $20.2 134,259 I By Spouse
Common Stock 01/16/2012 G 5,144 A $20.2 249,304 I By Trustee For Children Trust
Common Stock 04/24/2012 J 145,055 A $22.4 754,138 I By Trustee of Father's GRAT
Common Stock 04/24/2012 J 189,698 A $22.4 798,781 I By Trustee of Mother's GRAT
Common Stock 04/24/2012 J 224,510 A $22.4 545,000 I By Grantor Retained Annuity Trust
Common Stock 04/24/2012 J 224,510 D $22.4 120,256 D
Common Stock 05/09/2012 G 13,300 D $22.7 106,956 D
Common Stock 06/14/2012 G 1,000 D $22.7 105,956 D
Common Stock 06/14/2012 G 1,000 A $22.7 135,259 I By Spouse
Common Stock 06/14/2012 G 2,000 D $22.7 103,956 D
Common Stock 09/18/2012 J 155,804 D $22 389,196 I By Grantor Retained Annuity Trust
Common Stock 09/18/2012 J 155,804 A $22 261,760 D
Common Stock 12/13/2012 J 90,879 A $22.5 90,879 I Spouse Trustee of Recp Trust
Common Stock 12/13/2012 J 90,879 D $22.5 298,317 I By Grantor Retained Annuity Trust
Common Stock 12/17/2012 G 2,300 D $22.5 259,460 D
Common Stock 12/24/2012 J 135,000 D $22.5 259 I By Spouse
Common Stock 12/24/2012 J 135,000 A $22.5 135,000 I Spouse Irrev Trust
Common Stock 04/19/2012 J 232,633 D $22.4 754,138 I By Trustee of Father's GRAT
Common Stock 04/19/2012 J 232,633 D $22.4 754,138 I By Trustee of Mother's GRAT
Common Stock 04/19/2012 J 274,510 A $22.4 257,460 D
Common Stock 04/19/2012 J 274,510 D $22.4 298,317 I By Grantor Retained Annuity Trust
Common Stock 1,638.5759 I By 401(k)(1)
Common Stock 4,150 I By Custodian For Child
Common Stock 68,700.1736 I By ESOP(2)
Common Stock 66,006 I By Trustee of Brother's Trust
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. Acquired under the Publix Super Markets, Inc. 401(k) SMART Plan. Transaction exempt under rule 16b-3(c).
2. Acquired under the Publix Super Markets, Inc. Employee Stock Ownership Plan. Transaction exempt under rule 16b-3(c).
/s/ Monica Allman, POA on file for Mark Clayton Hollis, Jr 02/11/2013
** 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).
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.