UNITED STATES
SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
SCHEDULE 13G
Under the Securities Exchange Act of 1934
(Amendment No. 17)*
Fastenal Company
(Name of Issuer)
Common Stock
(Title of Class of Securities)
| 311900104 (CUSIP Number) |
December 31, 2004
(Date of Event Which Requires Filing of this Statement)
Check the appropriate box to designate the rule pursuant to which this Schedule is filed:
¨ Rule 13d-1(b)
¨ Rule 13d-1(c)
x Rule 13d-1(d)
| * | The remainder of this cover page shall be filled out for a reporting person’s initial filing on this form with respect to the subject class of securities, and for any subsequent amendment containing information which would alter the disclosures provided in a prior cover page. |
The information required in the remainder of this cover page shall not be deemed to be “filed” for the purpose of Section 18 of the Securities Exchange Act of 1934 (“Act”) or otherwise subject to the liabilities of that section of the Act but shall be subject to all other provisions of the Act (however, see the Notes).
| CUSIP No. 311900104 | 13G |
| 1 | NAMES OF REPORTING PERSONS I.R.S. IDENTIFICATION NOS. OF ABOVE PERSONS (ENTITIES ONLY)
Robert A. Kierlin |
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| 2 | CHECK THE APPROPRIATE BOX IF A MEMBER OF A GROUP* (a) ¨ (b) ¨
Not Applicable |
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| 3 | SEC USE ONLY
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| 4 | CITIZENSHIP OR PLACE OF ORGANIZATION
United States |
| NUMBER OF SHARES BENEFICIALLY OWNED BY EACH REPORTING PERSON WITH: |
5 SOLE VOTING POWER
5,418,302 6 SHARED VOTING POWER
85,200 7 SOLE DISPOSITIVE POWER
5,418,302 8 SHARED DISPOSITIVE POWER
85,200 |
| 9 | AGGREGATE AMOUNT BENEFICIALLY OWNED BY EACH REPORTING PERSON
5,503,502 |
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| 10 | CHECK IF THE AGGREGATE AMOUNT IN ROW (9) EXCLUDES CERTAIN SHARES*
Not Applicable |
¨
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| 11 | PERCENT OF CLASS REPRESENTED BY AMOUNT IN ROW (9)
7.3% |
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| 12 | TYPE OF REPORTING PERSON*
IN |
| * | SEE INSTRUCTION BEFORE FILLING OUT! |
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| Item 1. |
(a) |
Name of Issuer
Fastenal Company |
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| (b) |
Address of Issuer’s Principal Executive Offices
2001 Theurer Boulevard Winona, Minnesota 55987-1500 |
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| Item 2. |
(a) |
Name of Person Filing
This filing is made by Robert A. Kierlin |
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| (b) |
Address of Principal Business Office or, if none, Residence
Robert A. Kierlin Fastenal Company 2001 Theurer Boulevard Winona, Minnesota 55987-1500 |
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| (c) |
Citizenship
Robert A. Kierlin is a citizen of the United States |
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| (d) |
Title of Class of Securities
Common Stock, $.01 par value |
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| (e) |
CUSIP Number
311900104 |
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| Item 3. |
If this statement is filed pursuant to §§ 240.13d-1(b) or 240.13d-2(b) or (c), check whether the person filing is a: | |||||||||||
| (a) | ¨ | Broker or dealer registered under Section 15 of the Act. | ||||||||||
| (b) | ¨ | Bank as defined in Section 3(a)(6) of the Act. | ||||||||||
| (c) | ¨ | Insurance company as defined in Section 3(a)(19) of the Act. | ||||||||||
| (d) | ¨ | Investment company registered under Section 8 of the Investment Company Act of 1940. | ||||||||||
| (e) | ¨ | An investment adviser in accordance with § 240.13d-1(b)(1)(ii)(E). | ||||||||||
| (f) | ¨ | An employee benefit plan or endowment fund in accordance with § 240.13d-1(b)(1)(ii)(F). | ||||||||||
| (g) | ¨ | A parent holding company or control person in accordance with § 240.13d-1(b)(1)(ii)(G). | ||||||||||
| (h) | ¨ | A savings association as defined in Section 3(b) of the Federal Deposit Insurance Act. | ||||||||||
| (i) | ¨ | A church plan that is excluded from the definition of an investment company under Section 3(c)(14) of the Investment Company Act of 1940. | ||||||||||
| (j) | ¨ | Group, in accordance with § 240.13d-1(b)(1)(ii)(J). | ||||||||||
Not Applicable
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| Item 4. |
Ownership | |||||||||
| (a) | Amount Beneficially Owned
5,503,502 |
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| (b) | Percent of Class
7.3% |
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| (c) | Number of shares as to which such person has: | |||||||||
| (i) | Sole power to vote or to direct the vote
5,418,302 |
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| (ii) | Shared power to vote or to direct the vote
85,200 |
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| (iii) | Sole power to dispose or to direct the disposition of
5,418,302 |
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| (iv) | Shared power to dispose or to direct the disposition of
85,200 |
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| See Item 6 for further information regarding the nature of the reporting person’s beneficial ownership of certain of the above-referenced shares. | ||||||||||
| Item 5. |
Ownership of Five Percent or Less of a Class | |||||||||
| If this statement is being filed to report the fact that as of the date hereof the reporting person has ceased to be the beneficial owner of more than five percent of the class of securities, check the following ¨. | ||||||||||
| Item 6. |
Ownership of More than Five Percent on Behalf of Another Person. | |||||||||
| The shares listed in Item 4 include 200 shares held by the reporting person’s wife. The reporting person disclaims beneficial ownership of such shares. The reporting person’s wife has the right to receive and the power to direct the receipt of dividends from, and the proceeds of the sale of, the shares held by her. | ||||||||||
| The shares listed in Item 4 also include 85,000 shares held by Hiawatha Education Foundation, a Minnesota non-profit corporation (the “Foundation”). The reporting person is the sole member, and a director and officer, of the Foundation. The Foundation has the right to receive and the power to direct the receipt of dividends from, and the proceeds of the sale of, the shares held by it. The sole member, directors and certain officers of the Foundation, including the reporting person, have the power, directly or indirectly, to authorize actions on behalf of the Foundation, but have no right as such to share in any dividends from, or any proceeds of the sale of, the shares held by such entity. | ||||||||||
| Item 7. | Identification and Classification of the Subsidiary Which Acquired the Security Being Reported on By the Parent Holding Company | |||||||||
| Not Applicable | ||||||||||
| Item 8. | Identification and Classification of Members of the Group | |||||||||
| Not Applicable | ||||||||||
| Item 9. | Notice of Dissolution of Group | |||||||||
| Not Applicable | ||||||||||
| Item 10. | Certification | |||||||||
| Not Applicable | ||||||||||
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SIGNATURE
After reasonable inquiry and to the best of my knowledge and belief, I certify that the information set forth in this statement is true, complete and correct.
| February 5, 2005 |
| Date |
| /s/ Robert A. Kierlin |
| Signature |
| Robert A. Kierlin |
| Name/Title |
The original statement shall be signed by each person on whose behalf the statement is filed or his authorized representative. If the statement is signed on behalf of a person by his authorized representative other than an executive officer or general partner of the filing person, evidence of the representative’s authority to sign on behalf of such person shall be filed with the statement, provided, however, that a power of attorney for this purpose which is already on file with the Commission may be incorporated by reference. The name and any title of each person who signs the statement shall be typed or printed beneath his signature.
NOTE: Schedules filed in paper format shall include a signed original and five copies of the schedule, including all exhibits. See § 240.13d-7 for other parties for whom copies are to be sent.
Attention: Intentional misstatements or omissions of fact constitute Federal criminal violations (See 18 U.S.C. 1001).
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