0000899243-18-003871.txt : 20180214 0000899243-18-003871.hdr.sgml : 20180214 20180214170700 ACCESSION NUMBER: 0000899243-18-003871 CONFORMED SUBMISSION TYPE: 5 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20171231 FILED AS OF DATE: 20180214 DATE AS OF CHANGE: 20180214 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: RALES MITCHELL P CENTRAL INDEX KEY: 0001015014 FILING VALUES: FORM TYPE: 5 SEC ACT: 1934 Act SEC FILE NUMBER: 001-37654 FILM NUMBER: 18613437 BUSINESS ADDRESS: STREET 1: 11790 GLEN ROAD CITY: POTOMAC STATE: MD ZIP: 20854 BUSINESS PHONE: 301-299-2225 MAIL ADDRESS: STREET 1: 11790 GLEN ROAD CITY: POTOMAC STATE: MD ZIP: 20854 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 5 1 doc5.xml FORM 5 SUBMISSION X0306 5 2017-12-31 0 0 0 0001659166 Fortive Corp FTV 0001015014 RALES MITCHELL P 11790 GLEN ROAD POTOMAC MD 20854 1 0 0 0 Common Stock, par value $.01 2017-02-10 5 G 0 230000 0.00 D 3757853 D Common Stock, par value $.01 2017-02-10 5 G 0 20000 0.00 D 3737853 D Common Stock, par value $.01 2017-02-15 5 G 0 10647 0.00 D 3727206 D Common Stock, par value $.01 2017-02-15 5 G 0 10647 0.00 A 338234 I Through the Mitchell P. Rales Family Trust Common Stock, par value $.01 2017-03-06 5 G 0 2500000 0.00 D 1227206 D Common Stock, par value $.01 2017-03-06 5 G 0 2500000 0.00 A 17000000 I Through single-member LLCs Common Stock, par value $.01 2017-05-03 5 G 0 168662 0.00 D 1058544 D Common Stock, par value $.01 2017-05-03 5 G 0 168662 0.00 A 506896 I Through the Mitchell P. Rales Family Trust Common Stock, par value $.01 12585 I By Spouse The Reporting Person is the trustee of the Mitchell P. Rales Family Trust. The reported shares are held through single-member LLCs. The Reporting Person is the sole member of these LLCs. 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 purpose. /s/ Mitchell P. Rales 2018-02-14