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*
(Street)
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2. Issuer Name and Ticker or Trading Symbol
BELK INC [ NONE ] |
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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3. Date of Earliest Transaction
(Month/Day/Year) 08/07/2015 | ||||||||||||||||||||||||||
4. If Amendment, Date of Original Filed
(Month/Day/Year) |
6. Individual or Joint/Group Filing (Check Applicable Line)
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Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned | ||||||||||
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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 | ||||||
Class A Common Stock | 08/07/2015 | G | 37,500(1) | D | $0.00 | 616,911(2) | D | |||
Class A Common Stock | 154,890(3) | I | Trustee GRAT #1 | |||||||
Class A Common Stock | 142,304(4) | I | Trustee GRAT #2 | |||||||
Class A Common Stock | 35,201(5) | I | Spouse | |||||||
Class A Common Stock | 14,761(6) | I | Custodian | |||||||
Class A Common Stock | 147,527(7) | I | Trustee | |||||||
Class A Common Stock | 144,566(8) | I | Trustee | |||||||
Class A Common Stock | 143,515(9) | I | Trustee | |||||||
Class A Common Stock | 124,210(10) | I | Trustee | |||||||
Class A Common Stock | 402,284(11) | I | Trustee | |||||||
Class A Common Stock | 183,825(12) | I | Trusts, spouse and child are trustees | |||||||
Class A Common Stock | 23,750(13) | I | Trustee, Family Wealth Preservation Trust | |||||||
Class A Common Stock | 1,221,842(14) | I | Brothers Investment Company | |||||||
Class A Common Stock | 444,212(15) | I | Milburn Investment Company | |||||||
Class A Common Stock | 228,016(16) | I | Trustee | |||||||
Class B Common Stock | 40,177(17) | D | ||||||||
Class B Common Stock | 312(18) | I | Custodian | |||||||
Class B Common Stock | 1,720(19) | I | Trustee | |||||||
Class B Common Stock | 4,681(20) | I | Trustee | |||||||
Class B Common Stock | 5,732(21) | I | Trustee | |||||||
Class B Common Stock | 25,037(22) | I | Trustee |
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||||||||||
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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: |
1. 37,500 shares of Class A common stock were gifted by Reporting Person to a charity. |
2. 616,911 shares of Class A common stock are held in Reporting Person's name and/or Thomas M. Belk, Jr., Trustee U/A dated 1/18/94, Reporting Person's grantor trust. |
3. 154,890 shares of Class A common stock are held by Thomas M. Belk, Jr., Grantor Retained Annuity Trust dated January 27, 2006. Reporting Person is the Trustee. |
4. 142,304 shares of Class A common stock are held by Thomas M. Belk, Jr., Grantor Retained Annuity Trust dated 12-17-2010. Reporting Person is the Trustee. |
5. 35,201 shares of Class A common stock are held by Reporting Person's spouse, Sarah F. Belk and/or her grantor trust, Sarah Fortune Belk Revocable Trust dated 12-11-07. |
6. 14,761 shares of Class A common stock are held by Reporting Person as custodian of his minor child. |
7. 147,527 shares of Class A common stock are held by Adelaide Lucinda Fortune Belk Irrevocable Trust dated August 23, 2010. Voting and investment power is shared by Adelaide Lucinda Fortune Belk, Thomas M. Belk, Jr. and Sarah F. Belk, the trustees. |
8. 144,566 shares of Class A common stock are held by Thomas M. Belk, III Irrevocable Trust dated 9-7-2010. Voting and investment power is shared by Thomas M. Belk, III, Thomas M. Belk, Jr. and Sarah F. Belk, the trustees. |
9. 143,515 shares of Class A common stock are held by Katherine McKay Belk Irrevocable Trust dated August 29, 2012. Voting and investment power is shared by Katherine McKay Belk, Thomas M. Belk, Jr. and Sarah F. Belk, the trustees. |
10. 124,210 shares of Class A common stock are held by Margaret Elizabeth Belk Irrevocable Trust dated March 27, 2015. Voting and investment power is shared by Margaret Elizabeth Belk, Thomas M. Belk, Jr. and Sarah F. Belk, the trustees. |
11. 402,284 shares of Class A common stock are held by Katherine McKay Belk Irrevocable Trust dated November 6, 2000. Voting and investment power is shared by Katherine McKay Belk, Thomas M. Belk, Jr., H.W. McKay Belk, John R. Belk and Katherine Belk Morris. |
12. 36,765 shares of Class A common stock are held by each of the following trusts: Thomas M. Belk, Jr. & Sarah F. Belk Family Wealth Preservation Trust dated November 28, 2012, f/b/o Adelaide Lucinda Fortune Belk; Thomas M. Belk, Jr. & Sarah F. Belk Family Wealth Preservation Trust dated November 28, 2012, f/b/o Thomas Milburn Belk, III; Thomas M. Belk, Jr. & Sarah F. Belk Family Wealth Preservation Trust dated November 28, 2012, f/b/o Katherine Whitner Belk; Thomas M. Belk, Jr. & Sarah F. Belk Family Wealth Preservation Trust dated November 28, 2012, f/b/o Margaret Elizabeth Belk; and Thomas M. Belk, Jr. & Sarah F. Belk Family Wealth Preservation Trust dated November 28, 2012, f/b/o Louisa Alexandra Belk. Sarah F. Belk, Reporting Person's wife, and the child that is beneficiary of the trust are trustees of each trust. |
13. 23,750 shares of Class A common stock are held by The Katherine McKay Belk FWP Trust f/b/o Thomas M. Belk, Jr. Descendants dated June 3, 2015. Reporting Person is the Trustee. |
14. 1,221,842 shares of Class A common stock are held by Brothers Investment Company, which corporation is equally owned by John M. Belk QTIP GST Non-Exempt Marital Trust, Wells Fargo Bank, N.A., Susan N. Jamison and Katherine B. Morris, Co-Trustees ("John M. Belk QTIP GST Non-Exempt Marital Trust") and the heirs of Thomas M. Belk. The co-trustees of John M. Belk QTIP GST Non-Exempt Marital Trust and Katherine McKay Belk, Thomas M. Belk, Jr., H.W. McKay Belk, John R. Belk and Katherine Belk Morris, heirs of Thomas M. Belk, share voting and investment power. |
15. 444,212 shares of Class A common stock are held by Milburn Investment Company. Voting and investment power is shared by Katherine McKay Belk, Thomas M. Belk, Jr., H.W. McKay Belk, John R. Belk and Katherine Belk Morris. |
16. 228,016 Class A shares held in a trust established by the Will of W.H. Belk for the benefit of Thomas M. Belk. Sarah Belk Gambrell, Katherine Belk Morris, Thomas M. Belk, Jr., H.W. McKay Belk and John R. Belk, the trustees, share voting and investment power. |
17. 18,552 shares of Class B common stock are held in Reporting Person's name and/or Thomas M. Belk, Jr., Trustee U/A dated 1/18/94, Reporting Person's grantor trust. 21,625 of the shares from the Belk, Inc. Executive Long Term Incentive Compensation Plan XV are not payable to the Reporting Person until 2016. |
18. 312 shares of Class B common stock are held by Reporting Person as custodian of his minor child. |
19. 1,720 shares of Class B common stock are held by Adelaide Lucinda Fortune Belk Irrevocable Trust dated August 23, 2010. Voting and investment power is shared by Adelaide Lucinda Fortune Belk, Thomas M. Belk, Jr. and Sarah F. Belk, the trustees. |
20. 4,681 shares of Class B common stock are held by Thomas M. Belk, III Irrevocable Trust dated 9-7-2010. Voting and investment power is shared by Thomas M. Belk, III, Thomas M. Belk, Jr. and Sarah F. Belk, the trustees. |
21. 5,732 shares of Class B common stock are held by Katherine McKay Belk Irrevocable Trust dated August 29, 2012. Voting and investment power is shared by Katherine McKay Belk, Thomas M. Belk, Jr. and Sarah F. Belk, the trustees. |
22. 25,037 shares of Class B common stock are held by Margaret Elizabeth Belk Irrevocable Trust dated March 27, 2015. Voting and investment power is shared by Margaret Elizabeth Belk, Thomas M. Belk, Jr. and Sarah F. Belk, the trustees. |
Remarks: |
Thomas M. Belk, Jr. by Holly C. Williamson, POA | 08/11/2015 | |
** 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. |