0001179110-17-000484.txt : 20170105 0001179110-17-000484.hdr.sgml : 20170105 20170105153924 ACCESSION NUMBER: 0001179110-17-000484 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20170103 FILED AS OF DATE: 20170105 DATE AS OF CHANGE: 20170105 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: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-16125 FILM NUMBER: 17510419 MAIL ADDRESS: STREET 1: 2413 ADVANCE ROAD CITY: MADISON STATE: WI ZIP: 53718 4 1 edgar.xml FORM 4 - X0306 4 2017-01-03 0 0000815556 FASTENAL CO FAST 0001555049 Polipnick Gary A. 2413 ADVANCE ROAD MADISON WI 53718 0 1 0 0 Executive Vice President Common Stock 61059 D Common Stock 898 I Held by Spouse Common Stock 1862 I Held in custodian account for Daughter Common Stock 963 I Held in custodian account for Daughter Common Stock 7247 I Held in 401(K) Plan Employee Stock Option (Right to Buy) 47 2017-01-03 4 A 0 9574 0 A 2026-12-31 Common Stock 9574 9574 D These options will fully vest and become exercisable over a period of five years, with 50% vesting and becoming exercisable halfway through the relevant vesting period, and the remainder vesting and becoming exercisable incrementally (20%, 20% and 10%) each year thereafter. Shares attributed to reporting person's account within issuer's 401(K) Plan as of December 31, 2016. Includes 1,735 shares maintained in a self-directed IRA. Reporting person disclaims beneficial ownership of these shares. /s/ John J. Milek, Attorney-in-Fact 2017-01-05