0001209191-12-059679.txt : 20121228 0001209191-12-059679.hdr.sgml : 20121228 20121228170041 ACCESSION NUMBER: 0001209191-12-059679 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20121226 FILED AS OF DATE: 20121228 DATE AS OF CHANGE: 20121228 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: BELK THOMAS M JR CENTRAL INDEX KEY: 0001247020 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-26207 FILM NUMBER: 121291543 MAIL ADDRESS: STREET 1: 2801 WEST TYVOLA RD CITY: CHARLOTTE STATE: NC ZIP: 282174500 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: BELK INC CENTRAL INDEX KEY: 0001051771 STANDARD INDUSTRIAL CLASSIFICATION: RETAIL-DEPARTMENT STORES [5311] IRS NUMBER: 562058574 FISCAL YEAR END: 0128 BUSINESS ADDRESS: STREET 1: 2801 WEST TYVOLA ROAD CITY: CHARLOTTE STATE: NC ZIP: 28217-4500 BUSINESS PHONE: 7043571000 MAIL ADDRESS: STREET 1: 2801 WEST TYVOLA ROAD CITY: CHARLOTTE STATE: NC ZIP: 28217-4500 4 1 doc4.xml FORM 4 SUBMISSION X0306 4 2012-12-26 0 0001051771 BELK INC NONE 0001247020 BELK THOMAS M JR C/O BELK, INC. 2801 WEST TYVOLA ROAD CHARLOTTE NC 28217-4500 1 1 1 0 Chairman & CEO Class A Common Stock 2012-12-26 4 G 0 183825 0.00 D 474255 D Class A Common Stock 175361 I Trustee GRAT #1 Class A Common Stock 178833 I Trustee GRAT #2 Class A Common Stock 34380 I Spouse Class A Common Stock 40891 I Custodian Class A Common Stock 145371 I Trustee Class A Common Stock 142410 I Trustee Class A Common Stock 141359 I Trustee Class A Common Stock 537517 I Trustee Class A Common Stock 2012-12-26 4 G 0 183825 0.00 A 183825 I Trusts, spouse is a trustee Class A Common Stock 1221842 I Brothers Investment Company Class A Common Stock 444212 I Milburn Investment Company Class B Common Stock 3577 D Class B Common Stock 624 I Custodian Class B Common Stock 1083 I Trustee Class B Common Stock 4044 I Trustee Class B Common Stock 5732 I Trustee 183,825 shares of Class A common stock were gifted by Reporting Person to his children. 474,255 shares of Class A common stock are held in Reporting Person's name and/or Thomas M. Belk, Jr., Trustee U/A dated 1/18/94, Reporting Person's grantor trust. 175,361 shares of Class A common stock are held by Thomas M. Belk, Jr., Grantor Retained Annuity Trust dated January 27, 2006. Reporting Person is the Trustee. 178,833 shares of Class A common stock are held by Thomas M. Belk, Jr., Grantor Retained Annuity Trust dated 12-17-2010. Reporting Person is the Trustee. 34,380 shares of Class A common stock are held by Reporting Person's spouse, Sarah F. Belk and/or her grantor trust, Sarah Fortune Belk Revocable Trust dated 12-11-07. 40,891 shares of Class A common stock are held by Reporting Person as custodian of his minor children. 145,371 shares of Class A common stock are held by Adelaide Lucinda Fortune Belk Irrevocable Trust dated August 23, 2010. Voting and investment power is shared by Adelaide Lucinda Fortune Belk, Thomas M. Belk, Jr. and Sarah F. Belk, the trustees. 142,410 shares of Class A common stock are held by Thomas M. Belk, III Irrevocable Trust dated 9-7-2010. Voting and investment power is shared by Thomas M. Belk, III, Thomas M. Belk, Jr. and Sarah F. Belk, the trustees. 141,359 shares of Class A common stock are held by Katherine McKay Belk Irrevocable Trust dated August 29, 2012. Voting and investment power is shared by Katherine McKay Belk, Thomas M. Belk, Jr. and Sarah F. Belk, the trustees. 537,517 shares of Class A common stock are held by Katherine McKay Belk Irrevocable Trust dated November 6, 2000. Voting and investment power is shared by Katherine McKay Belk, Thomas M. Belk, Jr., H.W. McKay Belk, John R. Belk and Katherine Belk Morris. 36,765 shares of Class A common stock were received and are held by each of the following trusts: Thomas M. Belk, Jr. & Sarah F. Belk Family Wealth Preservation Trust dated November 28, 2012, f/b/o Adelaide Lucinda Fortune Belk; Thomas M. Belk, Jr. & Sarah F. Belk Family Wealth Preservation Trust dated November 28, 2012, f/b/o Thomas Milburn Belk, III; Thomas M. Belk, Jr. & Sarah F. Belk Family Wealth Preservation Trust dated November 28, 2012, f/b/o Katherine Whitner Belk; Thomas M. Belk, Jr. & Sarah F. Belk Family Wealth Preservation Trust dated November 28, 2012, f/b/o Margaret Elizabeth Belk; and Thomas M. Belk, Jr. & Sarah F. Belk Family Wealth Preservation Trust dated November 28, 2012, f/b/o Louisa Alexandra Belk. Sarah F. Belk, a trustee of each trust, is Reporting Person's wife. 1,221,842 shares of Class A common stock are held by Brothers Investment Company, which corporation is equally owned by John M. Belk QTIP GST Non-Exempt Marital Trust, Wells Fargo Bank, N.A., Susan N. Jamison and Katherine B. Morris, Co-Trustees ("John M. Belk QTIP GST Non-Exempt Marital Trust") and the heirs of Thomas M. Belk. The co-trustees of John M. Belk QTIP GST Non-Exempt Marital Trust and Katherine McKay Belk, Thomas M. Belk, Jr., H.W. McKay Belk, John R. Belk and Katherine Belk Morris, heirs of Thomas M. Belk, share voting and investment power. 444,212 shares of Class A common stock are held by Milburn Investment Company. Voting and investment power is shared by Katherine McKay Belk, Thomas M. Belk, Jr., H.W. McKay Belk, John R. Belk and Katherine Belk Morris. 3,577 shares of Class B common stock are held in Reporting Person's name and/or Thomas M. Belk, Jr., Trustee U/A dated 1/18/94, Reporting Person's grantor trust. 624 shares of Class B common stock are held by Reporting Person as custodian of his minor children. 1,083 shares of Class B common stock are held by Adelaide Lucinda Fortune Belk Irrevocable Trust dated August 23, 2010. Voting and investment power is shared by Adelaide Lucinda Fortune Belk, Thomas M. Belk, Jr. and Sarah F. Belk, the trustees. 4,044 shares of Class B common stock are held by Thomas M. Belk, III Irrevocable Trust dated 9-7-2010. Voting and investment power is shared by Thomas M. Belk, III, Thomas M. Belk, Jr. and Sarah F. Belk, the trustees. 5,732 shares of Class B common stock are held by Katherine McKay Belk Irrevocable Trust dated August 29, 2012. Voting and investment power is shared by Katherine McKay Belk, Thomas M. Belk, Jr. and Sarah F. Belk, the trustees. Thomas M. Belk, Jr. by Betty F. Buchanan, POA 2012-12-28