SEC FORM 3 SEC Form 3
FORM 3 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES

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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1. Name and Address of Reporting Person*
KOBAYASHI MICHAEL K

(Last) (First) (Middle)
5130 HACIENDA DRIVE

(Street)
DUBLIN CA 94568

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
08/16/2019
3. Issuer Name and Ticker or Trading Symbol
ROSS STORES, INC. [ ROST ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director 10% Owner
X Officer (give title below) Other (specify below)
President, Ops. & Technology
5. 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 Beneficially Owned
1. Title of Security (Instr. 4) 2. Amount of Securities Beneficially Owned (Instr. 4) 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 4. Nature of Indirect Beneficial Ownership (Instr. 5)
Common Stock 85,289 D
Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 4) 2. Date Exercisable and Expiration Date (Month/Day/Year) 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) 4. Conversion or Exercise Price of Derivative Security 5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 6. Nature of Indirect Beneficial Ownership (Instr. 5)
Date Exercisable Expiration Date Title Amount or Number of Shares
Explanation of Responses:
/s/ T. Marquette for Mike Kobayashi 08/19/2019
** 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 5 (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
The undersigned hereby designates and appoints as his/her 
attorney-in-fact and authorizes each of: Travis Marquette, Group 
Senior Vice President, Chief Financial Officer; Ken Jew, Group 
Senior Vice President, General Counsel and Corporate Secretary; 
Deon Riley, Group Senior Vice President, Human Resources; Kevin 
Reimann, Senior Vice President, Human Resources; and Marcia 
Casey, Vice President, Human Resources 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 3, 4, and 5, and any amendments 
thereto, and to 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 5th day of August 2019.
/s/ Michael Kobayashi