0001179110-17-014728.txt : 20171130 0001179110-17-014728.hdr.sgml : 20171130 20171130162214 ACCESSION NUMBER: 0001179110-17-014728 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20171128 FILED AS OF DATE: 20171130 DATE AS OF CHANGE: 20171130 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: 171231520 MAIL ADDRESS: STREET 1: 2413 ADVANCE ROAD CITY: MADISON STATE: WI ZIP: 53718 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 4 1 edgar.xml FORM 4 - X0306 4 2017-11-28 0 0000815556 FASTENAL CO FAST 0001555049 Polipnick Gary A. 2413 ADVANCE ROAD MADISON WI 53718 0 1 0 0 Executive Vice President Common Stock 2017-11-28 4 M 0 30000 27 A 91059 D Common Stock 2017-11-28 4 S 0 30000 50.0287 D 61059 D Common Stock 7539 I Held in 401(K) Plan Employee Stock Option (Right to Buy) 27 2017-11-28 4 M 0 30000 0 D 2018-05-31 Common Stock 30000 0 D The options will fully vest and become exercisable over a period of eight years, with 50% of the options vesting and becoming exercisable half way through the relevant vesting period, and the remainder vesting and becoming exercisable proportionately each year thereafter. Shares attributed to reporting person's account within issuer's 401(K) Plan as of November 30, 2017 and includes 292 shares added to this account since the reporting person's last holdings report filed on January 5, 2017. Includes 1,735 shares maintained in a self-directed IRA. /s/ John J. Milek, Attorney-in-Fact 2017-11-30