SEC Form 5
FORM 5	UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

ANNUAL 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:	
3235-0362	

Estimated average burden	

hours per response:	
1.0	

	

	

	Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).	 	 	

	Form 3 Holdings Reported.	 	 	

	Form 4 Transactions Reported.	 	 	
1. Name and Address of Reporting Person *
FASSIO JAMES S	

(Last)	
(First)	
(Middle)	

4440 ROSEWOOD DRIVE, BUILDING 4	

 	

(Street)
PLEASANTON	
CA	
94588	

(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)
 	
Director	
 	
10% Owner	

X	
Officer (give title below)	
 	
Other (specify below)	

President, Chief Dev. Officer	

	 	
 	3. Statement for Issuer's Fiscal Year Ended (Month/Day/Year)
02/02/2013	 	 	 	
 	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 at end of Issuer's Fiscal Year (Instr. 3 and 4)	6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)	7. Nature of Indirect Beneficial Ownership (Instr. 4)	 	 	 	 	 	 	 	
 	 	 	 	Amount	(A) or (D)	Price	 	 	 	 	 	 	 	 	 	 	 	 	
Common Stock	04/14/2003	 	G5	12,255	D	$0.00	479,696(2)	D	 	 	 	 	 	 	 	 	 	 	
Common Stock	04/14/2003	 	G5	12,255	A	$0.00	12,255	I	by Trust A (1)	 	 	 	 	 	 	 	 	 	
Common Stock	12/31/2004	 	G5	206	D	$0.00	479,490	D	 	 	 	 	 	 	 	 	 	 	
Common Stock	12/31/2004	 	G5	206	A	$0.00	12,461	I	by Trust A (1)	 	 	 	 	 	 	 	 	 	
Common Stock	03/22/2005	 	G5	1,227	D	$0.00	478,263	D	 	 	 	 	 	 	 	 	 	 	
Common Stock	03/22/2005	 	G5	1,227	A	$0.00	13,688	I	by Trust A (1)	 	 	 	 	 	 	 	 	 	
Common Stock	06/30/2008	 	G5	208	D	$0.00	478,055	D	 	 	 	 	 	 	 	 	 	 	
Common Stock	06/30/2008	 	G5	208	A	$0.00	13,896	I	by Trust A (1)	 	 	 	 	 	 	 	 	 	
Common Stock	09/30/2008	 	G5	396	D	$0.00	477,659	D	 	 	 	 	 	 	 	 	 	 	
Common Stock	09/30/2008	 	G5	396	A	$0.00	14,292	I	by Trust A (1)	 	 	 	 	 	 	 	 	 	
Common Stock	12/31/2008	 	G5	226	D	$0.00	477,433	D	 	 	 	 	 	 	 	 	 	 	
Common Stock	12/31/2008	 	G5	226	A	$0.00	14,518	I	by Trust A (1)	 	 	 	 	 	 	 	 	 	
Common Stock	02/09/2009	 	G5	55,770	D	$0.00	421,663	D	 	 	 	 	 	 	 	 	 	 	
Common Stock	02/09/2009	 	G5	55,770	A	$0.00	70,288	I	by Trust A (1)	 	 	 	 	 	 	 	 	 	
Common Stock	03/31/2009	 	G5	15,052	D	$0.00	406,611	D	 	 	 	 	 	 	 	 	 	 	
Common Stock	03/31/2009	 	G5	15,052	A	$0.00	85,340	I	by Trust A (1)	 	 	 	 	 	 	 	 	 	
Common Stock	06/30/2009	 	G5	380	D	$0.00	406,231	D	 	 	 	 	 	 	 	 	 	 	
Common Stock	06/30/2009	 	G5	380	A	$0.00	85,720	I	by Trust A (1)	 	 	 	 	 	 	 	 	 	
Common Stock	09/30/2009	 	G5	308	D	$0.00	405,923	D	 	 	 	 	 	 	 	 	 	 	
Common Stock	09/30/2009	 	G5	308	A	$0.00	86,028	I	by Trust A (1)	 	 	 	 	 	 	 	 	 	
Common Stock	12/31/2009	 	G5	138	D	$0.00	405,785	D	 	 	 	 	 	 	 	 	 	 	
Common Stock	12/31/2009	 	G5	138	A	$0.00	86,166	I	by Trust A (1)	 	 	 	 	 	 	 	 	 	
Common Stock	03/16/2010	 	G5	14,384	D	$0.00	391,401	D	 	 	 	 	 	 	 	 	 	 	
Common Stock	03/16/2010	 	G5	14,384	A	$0.00	100,550	I	by Trust A (1)	 	 	 	 	 	 	 	 	 	
Common Stock	03/31/2010	 	G5	274	D	$0.00	391,127	D	 	 	 	 	 	 	 	 	 	 	
Common Stock	03/31/2010	 	G5	274	A	$0.00	100,824	I	by Trust A (1)	 	 	 	 	 	 	 	 	 	
Common Stock	04/12/2010	 	G5	26,492	D	$0.00	364,635	D	 	 	 	 	 	 	 	 	 	 	
Common Stock	04/12/2010	 	G5	26,492	A	$0.00	127,316	I	by Trust A (1)	 	 	 	 	 	 	 	 	 	
Common Stock	06/30/2010	 	G5	274	D	$0.00	364,361	D	 	 	 	 	 	 	 	 	 	 	
Common Stock	06/30/2010	 	G5	274	A	$0.00	127,590	I	by Trust A (1)	 	 	 	 	 	 	 	 	 	
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)	 	
 	 	 	 	 	(A)	(D)	Date Exercisable	Expiration Date	Title	Amount or Number of Shares	 	 	 	 	 	 	 	 	 	
Explanation of Responses:	
1. Securities held in the name of James S. Fassio Revocable Trust.	
2. Securities Beneficially Owned includes shares acquired pursuant to issuer's employee stock purchase plan in a transaction exempt under Rule 16b-3.	
Remarks:	
One of Two Forms	
 	/s/ JAMES S. FASSIO President, Chief Development Officer	03/13/2013	
 	** 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
The undersigned hereby authorizes John G. Call, Group Senior Vice 
President; Deon Riley, Senior Vice President, Human Resources; 
Ken Jew, Vice President, Corporate Counsel and Assistant 
Corporate Secretary; and Monte Young, Senior Director, 
Compensation-HRIM 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 7th day of March, 2013.  

/s/ James Fassio

SV\340998.1