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
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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*
BELK KATHERINE MCKAY

(Last) (First) (Middle)
C/O BELK, INC.
2801 WEST TYVOLA ROAD

(Street)
CHARLOTTE NC 28217-4500

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
BELK INC [ NONE ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director X 10% Owner
Officer (give title below) Other (specify below)
3. Date of Earliest Transaction (Month/Day/Year)
09/23/2015
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
Class A Common Stock 787,398(1) D
Class A Common Stock 307,330(2) I Trustee, Charitable Remainder Unitrust
Class A Common Stock 46,801(3) I Trustee, 2012 GRAT
Class A Common Stock 109,874(4) I Trustee, 2013 GRAT
Class A Common Stock 223,002(5) I Trustee, 2014 GRAT
Class A Common Stock 120,800(6) I Trustee, 2015 GRAT
Class A Common Stock 09/23/2015 J 88,197(7) D $0.00 109,449(8) I Custodian
Class A Common Stock 100(9) I Spouse (deceased)
Class A Common Stock 1,221,842(10) I Brothers Investment Company
Class A Common Stock 444,212(11) I Milburn Investment Company
Class B Common Stock 24,725(12) I Custodian
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:
1. 787,398 shares of Class A common stock are held in Reporting Person's name and/or Katherine McKay Belk Trust dated November 6, 2000, Reporting Person's grantor trust. Voting and investment power of the grantor trust is shared by Katherine McKay Belk, Thomas M. Belk, Jr., H.W. McKay Belk, John R. Belk and Katherine Belk Morris.
2. 307,330 shares of Class A common stock are held by Katherine McKay Belk Cook Charitable Remainder Unitrust. Reporting Person is the Trustee.
3. 46,801 shares of Class A common stock are held by Katherine McKay Belk 2012 Grantor Retained Annuity Trust dated July 24, 2012. Reporting Person is the Trustee.
4. 109,874 shares of Class A common stock are held by Katherine McKay Belk 2013 Grantor Retained Annuity Trust dated May 30, 2013. Reporting Person is the Trustee.
5. 223,002 shares of Class A common stock are held by Katherine McKay Belk 2014 Grantor Retained Annuity Trust dated April 23, 2014. Reporting Person is the Trustee.
6. 120,800 shares of Class A common stock are held by Katherine McKay Belk 2015 Grantor Retained Annuity Trust dated June 3, 2015. Reporting Person is the Trustee.
7. 88,197 shares of Class A common stock were transferred to a grandchild. Reporting Person held the stock as custodian.
8. 109,449 shares of Class A common stock are held by Reporting Person as custodian of her minor grandchild.
9. 100 shares of Class A common stock are held in the name of Reporting Person's husband (deceased), James Fielder Cook.
10. 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.
11. 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.
12. 24,725 shares of Class B common stock are held by Reporting Person as custodian of her minor grandchild.
Remarks:
Katherine McKay Belk by Holly C. Williamson, POA 09/24/2015
** 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.