SEC FORM 4 SEC Form 4
FORM 4 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP

Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934
or Section 30(h) of the Investment Company Act of 1940
 
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Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
1. Name and Address of Reporting Person*
SEILER DONALD H

(Last) (First) (Middle)
8333 CENTRAL AVE

(Street)
NEWARK CA 94560

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
ROSS STORES INC [ ROST ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director 10% Owner
Officer (give title below) Other (specify below)
3. Date of Earliest Transaction (Month/Day/Year)
12/12/2003
4. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
X Form filed by One Reporting Person
Form filed by More than One Reporting Person
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
1. Title of Security (Instr. 3) 2. Transaction Date (Month/Day/Year) 2A. Deemed Execution Date, if any (Month/Day/Year) 3. Transaction Code (Instr. 8) 4. Securities Acquired (A) or Disposed Of (D) (Instr. 3, 4 and 5) 5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4) 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 7. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V Amount (A) or (D) Price
COMMON STOCK 12/12/2003 M 4,000 A $23 272,340 D
COMMON STOCK 12/12/2003 M 4,000 A $17.9375 276,340 D
COMMON STOCK 12/12/2003 M 667 A $39.6 277,007 D
COMMON STOCK 12/12/2003 M 2,000 A $21.5625 279,007 D
COMMON STOCK 12/12/2003 M 2,000 A $21.0625 281,007 D
COMMON STOCK 12/12/2003 M 2,000 A $13.3125 283,007 D
COMMON STOCK 12/12/2003 M 2,000 A $41.79 285,007 D
COMMON STOCK 12/12/2003 M 3,333 A $23.91 288,340 D
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 3) 2. Conversion or Exercise Price of Derivative Security 3. Transaction Date (Month/Day/Year) 3A. Deemed Execution Date, if any (Month/Day/Year) 4. Transaction Code (Instr. 8) 5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) 6. Date Exercisable and Expiration Date (Month/Day/Year) 7. Title and Amount of Securities Underlying Derivative Security (Instr. 3 and 4) 8. Price of Derivative Security (Instr. 5) 9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) 10. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 11. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V (A) (D) Date Exercisable Expiration Date Title Amount or Number of Shares
Non-Qualified Stock Option $13.3125 12/12/2003 M 2,000 12/12/2003(1) 03/18/2007 Common stock 2,000 $0 0 D
Non-Qualified Stock Option $17.9375 12/12/2003 M 4,000 12/12/2003(1) 06/07/2010 common stock 4,000 $0 0 D
Non-Qualified Stock Option $21.0625 12/12/2003 M 2,000 12/12/2003(1) 03/18/2008 common stock 2,000 $0 0 D
Non-Qualified Stock Option $21.5625 12/12/2003 M 2,000 12/12/2003(1) 03/18/2009 common stock 2,000 $0 0 D
Non-Qualified Stock Option $23 12/12/2003 M 4,000 12/12/2003(1) 05/27/2009 common stock 4,000 $0 0 D
Non-Qualified Stock Option $23.91 12/12/2003 M 3,333 12/12/2003(2) 05/31/2011 common stock 3,333 $0 667 D
Non-Qualified Stock Option $39.6 12/12/2003 M 667 12/12/2003(2) 05/21/2013 common stock 667 $0 3,333 D
Non-Qualified Stock Option $41.79 12/12/2003 M 2,000 12/12/2003(2) 05/23/2012 common stock 2,000 $0 2,000 D
Explanation of Responses:
1. OPTION IS FULLY VESTED AND EXERCISABLE
2. Grant to reporting person of an option which begins vesting six months from grant date(Initial Vest Date). On initial vest date, grant vests and becomes exercisable as to 1/6 of shares granted and becomes exercisable as to 1/36 of shares granted per month thereafter
Donald Seiler 12/12/2003
** Signature of Reporting Person Date
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
* If the form is filed by more than one reporting person, see Instruction 4 (b)(v).
** Intentional misstatements or omissions of facts constitute Federal Criminal Violations See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure.
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number.