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