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
|
| OMB APPROVAL |
| OMB Number: |
3235-0287 |
| Estimated average burden |
| hours per response: |
0.5 |
|
|
 |
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*
| 4440 ROSEWOOD DRIVE, BUILDING 4 |
|
(Street)
|
2. Issuer Name and Ticker or Trading Symbol
ROSS STORES INC
[ ROST ]
|
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
|
Director |
|
10% Owner |
| X |
Officer (give title below) |
|
Other (specify below) |
|
President, Chief Operating Off
|
|
3. Date of Earliest Transaction
(Month/Day/Year)
06/18/2010
|
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 |
06/18/2010 |
|
S |
|
188 |
D |
$57.48
|
212,701 |
D |
|
| Common Stock |
06/18/2010 |
|
S |
|
1,912 |
D |
$57.49
|
210,789 |
D |
|
| Common Stock |
06/18/2010 |
|
S |
|
6,797 |
D |
$57.5
|
203,992 |
D |
|
| Common Stock |
06/18/2010 |
|
S |
|
1,200 |
D |
$57.51
|
202,792 |
D |
|
| Common Stock |
06/18/2010 |
|
S |
|
600 |
D |
$57.53
|
202,192 |
D |
|
| Common Stock |
06/18/2010 |
|
S |
|
400 |
D |
$57.54
|
201,792 |
D |
|
| Common Stock |
06/18/2010 |
|
S |
|
800 |
D |
$57.55
|
200,992 |
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 |
| Explanation of Responses: |
|
/s/Michael B O'Sullivan President, Chief Operating Officer |
06/18/2010 |
|
** 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. |
ROSS STORES, INC.
POWER OF ATTORNEY
Know all by these presents, that the undersigned
hereby authorizes Mark LeHocky, Senior Vice President,
General Counsel, and Corporate Secretary; D. Jane
Marvin, Senior Vice President, Human Resources; Ken
Jew, Vice President, Corporate Counsel; Robert
Richardson, Jr., Sr. Director, Compensation; Ana
Drivon Brandau, Executive Compensation of Ross
Stores, Inc. (the "Company"), to execute for and on
behalf of the undersigned, in the undersigned's
capacity as an officer or director of the Company,
Form ID Uniform Application for Access Codes and
Passwords to File on EDGAR, Forms 4 and 5, and any
amendments thereto, and cause such form(s) to be filed
with the United States Securities and Exchange
Commission pursuant to Section 16(a) of the Securities
Act of 1934, relating to the undersigned's beneficial
ownership of securities in the Company. The
undersigned hereby grants to each such attorney-in-
fact full power and authority to do and perform any
and every act and thing whatsoever requisite,
necessary, or proper to be done in the exercise of any
of the rights and powers herein granted, as fully to
all intents and purposes as the undersigned might or
could do if personally present, with full power of
substitution or revocation, hereby ratifying and
confirming all that such attorney-in-fact, or such
attorney-in-fact's substitute or substitutes, shall
lawfully do or cause to be done by virtue of this
power of attorney and the rights and powers herein
granted. The undersigned acknowledges that the
foregoing attorneys-in-fact, in serving in such
capacity at the request of the undersigned, are not
assuming, nor is the Company assuming, any of the
undersigned's responsibilities to comply with
Section 16 of the Securities Exchange Act of 1934.
This Power of Attorney shall remain in full force and
effect until the undersigned is no longer required to
file Forms 4 and 5 with respect to the undersigned's
holdings of, and transactions in, securities issued by
the Company, unless earlier revoked by the undersigned
in a signed writing delivered to the foregoing
attorneys-in-fact.
In Witness Whereof, the undersigned has caused this
Power of Attorney to be executed as of this 17th day
of June, 2010.
(Signature) Michael B. O'Sullivan
\\newark1\data\LEGAL\Section 16\POA\Power of Attorney - 6-10.doc
SV\340998.1
