0001659166-17-000262.txt : 20171208 0001659166-17-000262.hdr.sgml : 20171208 20171208193411 ACCESSION NUMBER: 0001659166-17-000262 CONFORMED SUBMISSION TYPE: 5/A PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20161231 FILED AS OF DATE: 20171208 DATE AS OF CHANGE: 20171208 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Pringle William W CENTRAL INDEX KEY: 0001670864 FILING VALUES: FORM TYPE: 5/A SEC ACT: 1934 Act SEC FILE NUMBER: 001-37654 FILM NUMBER: 171248128 MAIL ADDRESS: STREET 1: C/O FORTIVE CORPORATION STREET 2: 6920 SEAWAY BOULEVARD CITY: EVERETT STATE: WA ZIP: 98203 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/A 1 wf-form5a_151277963685328.xml FORM 5/A X0306 5/A 2016-12-31 2017-01-04 0 0 0 0001659166 Fortive Corp FTV 0001670864 Pringle William W 6920 SEAWAY BLVD EVERETT WA 98203 0 1 0 0 Senior Vice President Common Stock 2016-12-28 5 G 0 L 193 0 D 5484 D Due to an administrative error, the Reporting Person did not include in the Reporting Person's original Form 5 for the fiscal year ended December 31, 2016 ("Original Form 5") a donation of 193 shares of the Issuer's Common Stock made by the Reporting Person on December 28, 2016 to a charitable organization ("12/16 Donation"). This amendment to the Original Form 5 is being made to report the 12/16 Donation. The amount identified in Column 5 of Table I of this amendment represents the number of shares of the Issuer's Common Stock owned by the Reporting Person as of December 28, 2016 following the 12/16 Donation and as of fiscal year ended December 31, 2016. As of December 8, 2017, the amount of shares of the Issuer's Common Stock beneficially owned by the Reporting Person was 13,973. Daniel B. Kim, as attorney-in-fact 2017-12-08