0001158449-15-000232.txt : 20151209 0001158449-15-000232.hdr.sgml : 20151209 20151209111258 ACCESSION NUMBER: 0001158449-15-000232 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20151201 FILED AS OF DATE: 20151209 DATE AS OF CHANGE: 20151209 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: ADVANCE AUTO PARTS INC CENTRAL INDEX KEY: 0001158449 STANDARD INDUSTRIAL CLASSIFICATION: RETAIL-AUTO & HOME SUPPLY STORES [5531] IRS NUMBER: 542049910 STATE OF INCORPORATION: DE FISCAL YEAR END: 0102 BUSINESS ADDRESS: STREET 1: 5008 AIRPORT RD CITY: ROANOKE STATE: VA ZIP: 24012 BUSINESS PHONE: 5403624911 MAIL ADDRESS: STREET 1: 5008 AIRPORT RD CITY: ROANOKE STATE: VA ZIP: 24012 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Brouillard John C. CENTRAL INDEX KEY: 0001291909 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-16797 FILM NUMBER: 151277784 MAIL ADDRESS: STREET 1: P.O. BOX 839999 STREET 2: 646 SOUTH MAIN AVENUE CITY: SAN ANTONIO STATE: TX ZIP: 78283-3999 4 1 wf-form4_144967756801002.xml FORM 4 X0306 4 2015-12-01 0 0001158449 ADVANCE AUTO PARTS INC AAP 0001291909 Brouillard John C. ADVANCE AUTO PARTS, INC. 5008 AIRPORT RD ROANOKE VA 24012 1 1 0 0 Executive Chairman Common Stock 2015-12-01 4 A 0 3080 162.34 A 27044 D Common Stock 857 I By grantor retained annuity trust The reported amount of time-based restricted stock units (RSUs) are subject to vesting one year from the grant date. On September 15, 2014, the reporting person contributed 7,500 shares of Advance Auto Parts, Inc. common stock to a grantor retained annuity trust (GRAT). The reporting person is the sole trustee and annuitant during the term of the GRAT. On August 18, 2015 and September 21, 2015, the reporting person received a distribution from the GRAT of 5,000 and 1,643 shares, respectively. /s/ Rachel E. Geiersbach, as Attorney-in-Fact for John C. Brouillard 2015-12-09