0001179110-16-018033.txt : 20160127 0001179110-16-018033.hdr.sgml : 20160127 20160127165958 ACCESSION NUMBER: 0001179110-16-018033 CONFORMED SUBMISSION TYPE: 5 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20151231 FILED AS OF DATE: 20160127 DATE AS OF CHANGE: 20160127 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 MAIL ADDRESS: STREET 1: 2001 THEURER BLVD CITY: WINONA STATE: MN ZIP: 55987 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Polipnick Gary A. CENTRAL INDEX KEY: 0001555049 FILING VALUES: FORM TYPE: 5 SEC ACT: 1934 Act SEC FILE NUMBER: 000-16125 FILM NUMBER: 161365744 MAIL ADDRESS: STREET 1: 2413 ADVANCE ROAD CITY: MADISON STATE: WI ZIP: 53718 5 1 edgar.xml FORM 5 - X0306 5 2015-12-31 0 0 0 0000815556 FASTENAL CO FAST 0001555049 Polipnick Gary A. 2413 ADVANCE ROAD MADISON WI 53718 0 1 0 0 Executive Vice President Common Stock 2015-12-31 5 L 0 17 40 A 59324 D Common Stock 1735 D Common Stock 2015-12-31 5 Z 0 1672 0 D 0 I By Trust Common Stock 1862 I Held in custodian account for Daughter Common Stock 963 I Held in custodian account for Daughter Common Stock 898 I Held by Spouse Common Stock 6838 I Held in 401(K) Plan Shares acquired in connection with a dividend reinvestment program. Shares maintained in self-directed IRA. Reporting person's spouse served as a Trustee of a Trust for the benefit of the spouse's sibling and the Trust was dissolved on December 31, 2015, whereby the shares held in the Trust transferred to spouse's sibling on this date. Shares attributed to reporting person's account within issuer's 401(K) Plan as of December 31, 2015. Reporting person disclaims beneficial ownership of these shares. /s/ John J. Milek, Attorney-in-Fact 2016-01-27