SEC Form 5 · accession 0000899243-17-003811

Fortive Corp · FTV

Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗

Reporting owner

Director

Period of report

Dec 31, 2016

Accepted (ET)

Feb 13, 2017 · 5:40 pm EST

Rule 10b5-1 plan

unknown — predates the checkbox

Issuer CIK

0001659166

Table I — non-derivative securities

Security	Date	Code	Shares	Price	A/D	Owned after	D/I	Nature of ownership
Common Stock, par value $.01^F1	Dec 1, 2016	G	358,000	$0.00	D	1,827,053	D
Common Stock, par value $.01	Dec 2, 2016	G	142,000	$0.00	D	1,685,053	D
Common Stock, par value $.01	Dec 7, 2016	G	138,379	$0.00	D	1,546,674	D
Common Stock, par value $.01	Dec 8, 2016	G	61,621	$0.00	D	1,485,053	D
Common Stock, par value $.01	Dec 15, 2016	J	2,500,000	$0.00	D	14,500,000	I	Through single-member LLCs
Common Stock, par value $.01	Dec 15, 2016	J	2,500,000	$0.00	A	3,985,053	D
Common Stock, par value $.01^F3	holding	—	—		—	327,587	I	Through the Mitchell P. Rales Family Trust
Common Stock, par value $.01^F4	holding	—	—		—	12,585	I	By Spouse
Common Stock, par value $.01	holding	—	—		—	68,448	I	By 401(k) Plan

No Table II lines on this filing.

F1The total number of shares includes 448,709 shares held through grantor retained annuity trusts of which the Reporting Person is the settlor, trustee and sole annuitant.
F2These shares were transferred from MPRDHR III LLC to direct ownership for no consideration. The MPRDHR III LLC is a limited liability company of which the Reporting Person is the sole member.
F3The Reporting Person is the trustee of the Mitchell P. Rales Family Trust.
F4The 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.