0001659166-16-000039.txt : 20160815 0001659166-16-000039.hdr.sgml : 20160815 20160815183727 ACCESSION NUMBER: 0001659166-16-000039 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 2 CONFORMED PERIOD OF REPORT: 20160804 FILED AS OF DATE: 20160815 DATE AS OF CHANGE: 20160815 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) 347-6100 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 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Hulit Barbara B. CENTRAL INDEX KEY: 0001682154 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-37654 FILM NUMBER: 161834310 MAIL ADDRESS: STREET 1: C/O FORTIVE CORPORATION STREET 2: 6920 SEAWAY BLVD CITY: EVERETT STATE: WA ZIP: 98203 3 1 wf-form3_147130063454270.xml FORM 3 X0206 3 2016-08-04 0 0001659166 Fortive Corp FTV 0001682154 Hulit Barbara B. 6920 SEAWAY BLVD EVERETT WA 98203 0 1 0 0 Senior Vice President Common Stock 3182 D Restricted Stock Unit Common Stock 13200.0 D Restricted Stock Unit Common Stock 6959.0 D Restricted Stock Unit Common Stock 15045.0 D Restricted Stock Unit Common Stock 12430.0 D Restricted Stock Unit Common Stock 6523.0 D Employee Stock Option (Right to Buy) 42.55 2026-02-24 Common Stock 63416.0 D Employee Stock Option (Right to Buy) 42.47 2025-02-24 Common Stock 39989.0 D Employee Stock Option (Right to Buy) 36.58 2024-05-15 Common Stock 17381.0 D Employee Stock Option (Right to Buy) 37.36 2024-02-24 Common Stock 37591.0 D Employee Stock Option (Right to Buy) 29.76 2023-02-21 Common Stock 46609.0 D Employee Stock Option (Right to Buy) 26.1 2022-02-23 Common Stock 48905.0 D Employee Stock Option (Right to Buy) 24.2 2021-02-23 Common Stock 34504.0 D Executive Deferred Incentive Program - Fortive Stock Fund Common Stock 22854.0 D In connection with the separation of the Issuer from Danaher Corporation ("Danaher"), Restricted Stock Units issued by Danaher on February 24, 2015 to the Reporting Person that remained unvested as of July 2, 2016 were converted into 13,200 Restricted Stock Units of the Issuer vesting in three equal annual installments beginning on February 24, 2018. Restricted stock units are payable in shares of common stock on a one-to-one basis. In connection with the separation of the Issuer from Danaher, Restricted Stock Units issued by Danaher on May 15, 2014 to the Reporting Person that remained unvested as of July 2, 2016 were converted into 6,959 Restricted Stock Units of the Issuer vesting in three equal annual installments beginning on May 15, 2017. In connection with the separation of the Issuer from Danaher, Restricted Stock Units issued by Danaher on February 24, 2014 to the Reporting Person that remained unvested as of July 2, 2016 were converted into 15,045 Restricted Stock Units of the Issuer vesting in three equal annual installments beginning on February 24, 2017. In connection with the separation of the Issuer from Danaher, Restricted Stock Units issued by Danaher on February 21, 2013 to the Reporting Person that remained unvested as of July 2, 2016 were converted into 12,430 Restricted Stock Units of the Issuer vesting in two remaining equal annual installments beginning on February 21, 2017. In connection with the separation of the Issuer from Danaher, Restricted Stock Units issued by Danaher on February 23, 2012 to the Reporting Person that remained unvested as of July 2, 2016 were converted into 6,523 Restricted Stock Units of the Issuer vesting on February 23, 2017. In connection with the separation of the Issuer from Danaher, options to purchase Danaher common stock issued by Danaher on February 24, 2016 to the Reporting Person that remained outstanding as of July 2, 2016 were converted into options to purchase 63,416 shares of Issuer's common stock vesting in three equal annual installments beginning on February 24, 2019. In connection with the separation of the Issuer from Danaher, options to purchase Danaher common stock issued by Danaher on February 24, 2015 to the Reporting Person that remained outstanding as of July 2, 2016 were converted into options to purchase 39,989 shares of Issuer's common stock vesting in three equal annual installments beginning on February 24, 2018. In connection with the separation of the Issuer from Danaher, options to purchase Danaher common stock issued by Danaher on May 15, 2014 to the Reporting Person that remained outstanding as of July 2, 2016 were converted into options to purchase 17,381 shares of Issuer's common stock vesting in three equal annual installments beginning on May 15, 2017. In connection with the separation of the Issuer from Danaher, options to purchase Danaher common stock issued by Danaher on February 24, 2014 to the Reporting Person that remained outstanding as of July 2, 2016 were converted into options to purchase 37,591 shares of Issuer's common stock vesting in three equal annual installments beginning on February 24, 2017. In connection with the separation of the Issuer from Danaher, options to purchase Danaher common stock issued by Danaher on February 21, 2013 to the Reporting Person that remained outstanding as of July 2, 2016 were converted into options to purchase 46,609 shares of Issuer's common stock, with options to purchase 15,536 shares fully vested and exercisable at the time of conversion and with the remainder of the options to purchase 31,073 shares vesting in two remaining equal annual installments beginning on February 21, 2017. In connection with the separation of the Issuer from Danaher, options to purchase Danaher common stock issued by Danaher on February 23, 2012 to the Reporting Person that remained outstanding as of July 2, 2016 were converted into options to purchase 48,905 shares of Issuer's common stock, with options to purchase 32,602 shares fully vested and exercisable at the time of conversion and with the remainder of the options to purchase 16,303 shares vesting on February 23, 2017. In connection with the separation of the Issuer from Danaher, options to purchase Danaher common stock issued by Danaher on February 23, 2011 to the Reporting Person that remained outstanding as of July 2, 2016 were converted into fully vested and exercisable options to purchase 34,504 shares of Issuer's common stock. In connection with the separation of the Issuer from Danaher, compensation of the Reporting Person deferred or contributed into Danaher's Executive Deferred Incentive Program was transferred to the Fortive Stock Fund in the Issuer's Executive Deferred Incentive Program ("EDIP Stock Fund") and, as of August 1, 2016, are deemed invested in 22,854 unfunded, fully vested, notional shares of the Issuer's common stock based on the closing price on August 1, 2016 of the Issuer's common stock. Upon termination of employment, the balance held by the Reporting Person in the EDIP Stock Fund will be settled in shares of the Issuer's common stock. The notional shares convert on a one-to-one basis. Daniel B. Kim, as attorney-in-fact 2016-08-14 EX-24 2 sec16poabhulit.htm POWER OF ATTORNEY

POWER OF ATTORNEY
Know all by these presents that the undersigned hereby constitutes and appoints Daniel B. Kim, signing singly, the undersigned's true and lawful attorney-in-fact to:
(1) execute for and on behalf of the undersigned, in the undersigned's capacity as an executive officer and/or director of Fortive Corporation (the "Company"), any Forms3, 4, and 5 in accordance with Section16(a) of the Securities Exchange Act of 1934 and the rules thereunder;
(2) do and perform any and all acts for and on behalf of the undersigned which may be necessary or desirable to complete and execute any such Form3, 4, or 5, complete and execute any amendment or amendments thereto, and timely file such form with the United States Securities and Exchange Commission and any stock exchange or similar authority; and
 (3) take any other action of any type whatsoever in connection with the foregoing which, in the opinion of such attorney-in-fact, may be of benefit to, in the best interest of, or legally required by, the undersigned, it being understood that the documents executed by such attorney-in-fact on behalf of the undersigned pursuant to this Power of Attorney shall be in such form and shall contain such terms and conditions as such attorney-in-fact may approve in such attorney-in-fact's discretion.
            The undersigned hereby grants to such attorney-in-fact full power and authority to do and perform any and every act and thing whatsoever requisite, necessary, or proper to be done in the exercise of any of the rights and powers herein granted, as fully to all intents and purposes as the undersigned might or could do if personally present, with full power of substitution or revocation, hereby ratifying and confirming all that such attorney-in-fact, or such attorney-in-fact's substitute or substitutes, shall lawfully do or cause to be done by virtue of this power of attorney and the rights and powers herein granted.  The undersigned acknowledges that the foregoing attorney-in-fact, in serving in such capacity at the request of the undersigned, is not assuming, nor is the Company assuming, any of the undersigned's responsibilities to comply with Section16 of the Securities Exchange Act of 1934.
 This Power of Attorney shall remain in full force and effect until the undersigned is no longer required to file Forms3, 4, and 5 with respect to the undersigned's holdings of and transactions in securities issued by the Company, unless earlier revoked by the undersigned in a signed writing delivered to the foregoing attorney-in-fact.
        IN WITNESS WHEREOF, the undersigned has caused this Power of Attorney to be executed as of this 4th day of August, 2016.
    By: /s/ Barbara Hulit
    Name:  Barbara Hulit
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