0000899243-16-024616.txt : 20160706 0000899243-16-024616.hdr.sgml : 20160706 20160706163434 ACCESSION NUMBER: 0000899243-16-024616 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20160705 FILED AS OF DATE: 20160706 DATE AS OF CHANGE: 20160706 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Fortive Corp CENTRAL INDEX KEY: 0001659166 STANDARD INDUSTRIAL CLASSIFICATION: INDUSTRIAL INSTRUMENTS FOR MEASUREMENT, DISPLAY, AND CONTROL [3823] IRS NUMBER: 000000000 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 6920 SEAWAY BLVD. CITY: EVERETT STATE: WA ZIP: 98203 BUSINESS PHONE: (425) 347-6100 MAIL ADDRESS: STREET 1: 6920 SEAWAY BLVD. CITY: EVERETT STATE: WA ZIP: 98203 FORMER COMPANY: FORMER CONFORMED NAME: TGA Holding Corp. DATE OF NAME CHANGE: 20151123 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: RALES STEVEN M CENTRAL INDEX KEY: 0001015013 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-37654 FILM NUMBER: 161754148 MAIL ADDRESS: STREET 1: 1250 24TH ST NW STREET 2: 8TH FL CITY: WASHINGTON STATE: DC ZIP: 20037 4 1 doc4.xml FORM 4 SUBMISSION X0306 4 2016-07-05 0 0001659166 Fortive Corp FTV 0001015013 RALES STEVEN M 2200 PENNSYLVANIA AVENUE, NW , SUITE 800W WASHINGTON DC 20037 1 0 0 0 Common Stock, par value $0.01 2016-07-05 4 A 0 1450 0.00 A 4508820 D Common Stock, par value $0.01 17000000 I Through single-member LLCs Common Stock, par value $0.01 6179 I By 401(k) Director Stock Option 48.60 2016-07-05 4 A 0 4340 0.00 A 2016-07-05 2026-07-05 Common Stock, par value $0.01 4340 4340 D Represents restricted stock units granted on July 5, 2016 and payable solely in common stock. The restricted stock units granted will vest at the earlier of July 5, 2017 or the date of the Issuer's 2017 annual meeting, but the underlying shares will not be issued until the earlier of the Reporting Person's death or the first day of the seventh month following due Reporting Person's retirement from the Board of Directors of the Issuer. Includes shares of Issuer common stock received in connection with the separation of Issuer from Danaher Corporation ("Danaher") and the distribution, by means of a pro rata dividend, of Issuer's common stock held by Danaher to the Danaher stockholders of record as of June 15, 2016 (except fractional shares, which will be aggregated and sold into the public market and the proceeds distributed to Danaher stockholders that otherwise would have received such fractional shares) (the "Distribution") in an exempt transaction pursuant to Rule 16a-9. Represents shares of Issuer common stock received in connection with the Distribution in an exempt transaction pursuant to Rule 16a-9. The reported shares are held through the following single-member LLCs: SMRDHR LLC, SMRDHR II LLC, SMRDHR III LLC and SMRDHR IV LLC. The Reporting Person is the sole member of each of these LLCs. /s/ Daniel B. Kim as Attorney-in-Fact 2016-07-06