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