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UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(h) of the Investment Company Act of 1940 |
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | |||
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 control number. | SEC 1474 (9-02) |
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 Underlying Securities (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 of Derivative Security: Direct (D) or Indirect (I) (Instr. 4) |
11. Nature of Indirect Beneficial Ownership (Instr. 4) |
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Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||||||
Stock Appreciation Right | $ 25.81 | 03/06/2012 | M | 4,061 (1) | (3) | 11/17/2015 | Common Stock | 4,061 | $ 0 | 0 | D | ||||
Stock Appreciation Right | $ 25.81 | 03/06/2012 | M | 2,000 (1) | (3) | 11/17/2015 | Common Stock | 2,000 | $ 0 | 14,240 | D | ||||
Stock Appreciation Right | $ 43.72 | 03/06/2012 | M | 2,367 (1) | (4) | 08/11/2015 | Common Stock | 2,367 | $ 0 | 0 | D |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
Broome Donna J ADVANCE AUTO PARTS, INC. 5008 AIRPORT RD ROANOKE, VA 24012 |
SVP, Team Member Excellence |
/s/ Rachel E. Geiersbach, as Attorney-in-Fact for Donna J. Broome | 03/07/2012 | |
**Signature of Reporting Person | Date |
* | 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). |
(1) | Represents the exercise by Ms.Broome of all her stock appreciation rights scheduled to expire on August 11, 2015 and November 17, 2015, consistent with Ms. Broome's regular practice. Following this transaction, Ms. Broome retains a substantial ownership commitment in beneficially owned stock and vested employee SARs, and she continues to satisfy the Company's stock ownership guidelines for executive officers. |
(2) | Represents shares withheld to satisfy exercise price and tax withholding obligation upon the exercise of stock appreciation rights (SARs). |
(3) | These shares became exercisable in three equal annual installments beginning on November 17, 2009. |
(4) | These shares became exercisable in three equal annual installments beginning on August 11, 2009. |