SEC Form 5 · accession 0000899243-19-002112
Fortive Corp · FTV
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Mitchell P Rales
Director
Period of report
Dec 31, 2018
Accepted (ET)
Jan 29, 2019 · 4:16 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 | Feb 12, 2018 | G | 8,721 | $0.00 | D | 1,049,823 | D | |
| Common Stock, par value $.01F1 | Feb 12, 2018 | G | 8,721 | $0.00 | A | 515,617 | I | Through the Mitchell P. Rales Family Trust |
| Common Stock, par value $.01F2 | May 2, 2018 | G | 51,139 | $0.00 | D | 2,002,329 | D | |
| Common Stock, par value $.01F1 | May 2, 2018 | G | 51,139 | $0.00 | A | 566,756 | I | Through the Mitchell P. Rales Family Trust |
| Common Stock, par value $.01F2,F3 | holding | — | — | — | 16,000,000 | I | Through single-member LLCs | |
| Common Stock, par value $.01F4 | holding | — | — | — | 12,585 | I | By Spouse |
Table II — derivative securities
No Table II lines on this filing.
Explanation of responses
- F1The Reporting Person is the trustee of the Mitchell P. Rales Family Trust.
- F2Total reflects a change in form of ownership pursuant to the exemption provided by Rule 16a-13 under the Securities Exchange Act of 1934, as amended.
- F3The reported shares are held through single-member LLCs. The Reporting Person is the sole member of these LLCs.
- 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.