SEC Form 5 · accession 0001127602-17-002921
PUBLIX SUPER MARKETS INC
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Tina P Johnson
10% Owner
Period of report
Dec 31, 2016
Accepted (ET)
Jan 30, 2017 · 4:59 pm EST
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0000081061
Table I — non-derivative securities
| Security | Date | Code | Shares | Price | A/D | Owned after | D/I | Nature of ownership |
|---|---|---|---|---|---|---|---|---|
| Common Stock | Apr 27, 2016 | J | 11,168 | $45.20 | D | 108,047 | I | By GRAT |
| Common Stock | Apr 27, 2016 | J | 11,168 | $45.20 | A | 178,811 | D | |
| Common Stock | Nov 30, 2016 | G | 11 | $40.15 | D | 178,800 | D | |
| Common StockF1 | holding | — | — | — | 1,892 | I | By 401(k) | |
| Common StockF2 | holding | — | — | — | 59,902 | I | By ESOP |
Table II — derivative securities
| Security | Conv. / exercise price | Date | Code | Shares | A/D | Exercisable | Expires | Underlying | Underlying shares | Owned after | D/I |
|---|---|---|---|---|---|---|---|---|---|---|---|
| SERP StockF3 | — | Mar 1, 2016 | A | 298 | A | — | — | Common Stock | 298 | 1,917 | I |
Explanation of responses
- F1Acquired under the Publix Super Markets, Inc. 401(k) SMART Plan. Transaction exempt under rule 16b-3(c).
- F2Acquired under the Publix Super Markets, Inc. Employee Stock Ownership Plan. Transaction exempt under rule 16b-3(c).
- F3Each share of SERP stock is the economic equivalent of one share of common stock. The shares of SERP stock become payable in common stock upon the reporting person's termination of employment in accordance with the Publix Super Markets, Inc. Supplemental Executive Retirement Plan.