0001209191-12-057658.txt : 20121214
0001209191-12-057658.hdr.sgml : 20121214
20121214114455
ACCESSION NUMBER: 0001209191-12-057658
CONFORMED SUBMISSION TYPE: 3
PUBLIC DOCUMENT COUNT: 2
CONFORMED PERIOD OF REPORT: 20121207
FILED AS OF DATE: 20121214
DATE AS OF CHANGE: 20121214
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Rose Timothy L.
CENTRAL INDEX KEY: 0001564691
FILING VALUES:
FORM TYPE: 3
SEC ACT: 1934 Act
SEC FILE NUMBER: 000-20355
FILM NUMBER: 121264705
MAIL ADDRESS:
STREET 1: 999 LAKE DRIVE
CITY: ISSAQUAH
STATE: WA
ZIP: 98027
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: COSTCO WHOLESALE CORP /NEW
CENTRAL INDEX KEY: 0000909832
STANDARD INDUSTRIAL CLASSIFICATION: RETAIL-VARIETY STORES [5331]
IRS NUMBER: 911223280
STATE OF INCORPORATION: WA
FISCAL YEAR END: 0902
BUSINESS ADDRESS:
STREET 1: 999 LAKE DRIVE
CITY: ISSAQUAH
STATE: WA
ZIP: 98027-
BUSINESS PHONE: 4253138100
MAIL ADDRESS:
STREET 1: 999 LAKE DRIVE
CITY: ISSAQUAH
STATE: WA
ZIP: 98027
FORMER COMPANY:
FORMER CONFORMED NAME: COSTCO COMPANIES INC
DATE OF NAME CHANGE: 19970401
FORMER COMPANY:
FORMER CONFORMED NAME: PRICE/COSTCO INC
DATE OF NAME CHANGE: 19930728
3
1
doc3.xml
FORM 3 SUBMISSION
X0206
3
2012-12-07
0
0000909832
COSTCO WHOLESALE CORP /NEW
COST
0001564691
Rose Timothy L.
999 LAKE DRIVE
ISSAQUAH
WA
98027
0
1
0
0
Executive VP
Common Stock
57402
D
Stock Option
40.69
2006-04-01
2015-04-01
Common Stock
26907
D
43,047 shares of common stock are unvested grants of Restricted Stock Units ("RSUs"). The vesting schedule for the RSUs are as follows: 27,272 shares will vest on October 22, 2013; 7,715 shares will vest on October 22, 2014; 4,301 shares will vest on October 22, 2015; 2,866 shares will vest on October 22, 2016; and 1,433 shares will vest on October 22, 2017. 3,049 shares represent additional RSUs resulting from the upward adjustment of outstanding unvested RSUs by a factor of 1.0763 in connection with the $7.00 per share special cash dividend payable by the issuer to shareholders of record on December 10, 2012. The adjustment was required under the plan documents governing the grants. The RSUs reported are subject to the same vesting schedules as the original RSUs to which they relate.
This option is fully vested.
This option, originally covering 25000 shares at an exercise price of $43.79 per share, has been adjusted with a lower exercise price and an increased number of options, in connection with the dividend referenced in note 1. The number of outstanding options was increased by a factor of 1.0763, and the option exercise price was reduced by dividing the price by that same factor. The adjustment was required under the governing plan documents.
Deanna K. Nakashima, attorney-in-fact
2012-12-14
EX-24.3_448270
2
poa.txt
POA DOCUMENT
LIMITED POWER OF ATTORNEY FOR
SECTION 16 REPORTING OBLIGATIONS
Know all by these presents, that the undersigned's hereby makes, constitutes
and appoints ________ as the undersigned's true and lawful attorney-in-fact,
with full power and authority as hereinafter described on behalf of and in the
name, place and stead of the undersigned to:
(1) prepare, execute, acknowledge, deliver and file Forms 3, 4, and 5 (including
any amendments thereto) with respect to the securities of __________________, a
_________ corporation (the "Company"), with the United States Securities and
Exchange Commission, any national securities exchanges and the Company, as
considered necessary or advisable under Section 16(a) of the Securities Exchange
Act of 1934 and the rules and regulations promulgated thereunder, as amended
from time to time (the "Exchange Act");
(2) seek or obtain, as the undersigned's representative and on the undersigned's
behalf, information on transactions in the Company's securities from any third
party, including brokers, employee benefit plan administrators and trustees, and
the undersigned hereby authorizes any such person to release any such
information to the undersigned and approves and ratifies any such release of
information; and
(3) perform any and all other acts which in the discretion of such
attorney-in-fact are necessary or desirable for and on behalf of the undersigned
in connection with the foregoing.
The undersigned acknowledges that:
(1) this Power of Attorney authorizes, but does not require, such
attorney-in-fact to act in their discretion on information provided to such
attorney-in-fact without independent verification of such information;
(2) any documents prepared and/or executed by such attorney-in-fact on behalf of
the undersigned pursuant to this Power of Attorney will be in such form and will
contain such information and disclosure as such attorney-in-fact, in his or her
discretion, deems necessary or desirable;
(3) neither the Company nor such attorney-in-fact assumes (i) any liability for
the undersigned's responsibility to comply with the requirement of the Exchange
Act, (ii) any liability of the undersigned for any failure to comply with such
requirements, or (iii) any obligation or liability of the undersigned for profit
disgorgement under Section 16(b) of the Exchange Act; and
(4) this Power of Attorney does not relieve the undersigned from responsibility
for compliance with the undersigned's obligations under the Exchange Act,
including without limitation the reporting requirements under Section 16 of the
Exchange Act.
The undersigned hereby gives and grants the foregoing attorney-in-fact full
power and authority to do and perform all and every act and thing whatsoever
requisite, necessary or appropriate to be done in and about the foregoing
matters as fully to all intents and purposes as the undersigned might or could
do if present, hereby ratifying all that such attorney-in-fact of, for and on
behalf of the undersigned, shall lawfully do or cause to be done by virtue of
this Limited Power of Attorney.
This Power of Attorney shall remain in full force and effect until revoked by
the undersigned in a signed writing delivered to such attorney-in-fact.
IN WITNESS WHEREOF, the undersigned has caused this Power of Attorney to be
executed as of this _______ day of ___________, ___________.
_________________________________
Signature
_________________________________
Print Name
STATE OF
COUNTY OF
On this ___________ day of ____________, ______________, ________________
personally appeared before me, and acknowledged that s/he executed the foregoing
instrument for the purposes therein contained.
IN WITNESS WHEREOF, I have hereunto set my hand and official seal.
_________________________________
Notary Public
_________________________________
My Commission Expires: