0000899243-17-015800.txt : 20170608
0000899243-17-015800.hdr.sgml : 20170608
20170608170049
ACCESSION NUMBER: 0000899243-17-015800
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20170606
FILED AS OF DATE: 20170608
DATE AS OF CHANGE: 20170608
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) 446-5000
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 MITCHELL P
CENTRAL INDEX KEY: 0001015014
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-37654
FILM NUMBER: 17900781
BUSINESS ADDRESS:
STREET 1: 2200 PENNSYLVANIA AVENUE NW
STREET 2: SUITE 800W
CITY: WASHINGTON
STATE: DC
ZIP: 20037
BUSINESS PHONE: 2028280850
MAIL ADDRESS:
STREET 1: 2200 PENNSYLVANIA AVENUE NW
STREET 2: SUITE 800W
CITY: WASHINGTON
STATE: DC
ZIP: 20037
4
1
doc4.xml
FORM 4 SUBMISSION
X0306
4
2017-06-06
0
0001659166
Fortive Corp
FTV
0001015014
RALES MITCHELL P
2200 PENNSYLVANIA AVENUE, NW
SUITE 800W
WASHINGTON
DC
20037
1
0
0
0
Common Stock, par value $0.01
2017-06-06
4
A
0
2800
0.00
A
3987853
D
Common Stock, par value $0.01
14500000
I
Through single-member LLCs
Common Stock, par value $0.01
327587
I
Through the Mitchell P. Rales Family Trust
Common Stock, par value $0.01
68388
I
By 401(k)
Common Stock, par value $0.01
12585
I
By spouse
Represents restricted stock units granted on June 6, 2017 and payable solely in common stock. The restricted stock units granted will vest at the earlier of June 6, 2018 or the date of the Issuer's 2018 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 the Reporting Person's retirement from the Board of Directors of the Issuer.
The reported shares are held through the following single-member LLCs: MPRDHR LLC, MPRDHR II LLC, MPRDHR III LLC, MPRDHR IV LLC and MPRDHR V LLC. The Reporting Person is the sole member of each of these LLCs.
The Reporting Person is the trustee of the Mitchell P. Rales Family Trust. The Reporting Person disclaims beneficial ownership of the shares held by the Mitchell P. Rales Family Trust, except to the extent of the Reporting Person's pecuniary interest.
The Reporting Person disclaims beneficial ownership of the shares held by his spouse, Emily W. Rales, and this report should not be deemed an admission that the Reporting Person is the beneficial owner of his spouse's shares for purposes of Section 16 or for any other purposes.
By: /s/ Mitchell P. Rales
2017-06-08