0001659166-17-000021.txt : 20170104 0001659166-17-000021.hdr.sgml : 20170104 20170104201351 ACCESSION NUMBER: 0001659166-17-000021 CONFORMED SUBMISSION TYPE: 5 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20161231 FILED AS OF DATE: 20170104 DATE AS OF CHANGE: 20170104 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 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Pringle William W CENTRAL INDEX KEY: 0001670864 FILING VALUES: FORM TYPE: 5 SEC ACT: 1934 Act SEC FILE NUMBER: 001-37654 FILM NUMBER: 17508268 MAIL ADDRESS: STREET 1: C/O FORTIVE CORPORATION STREET 2: 6920 SEAWAY BOULEVARD CITY: EVERETT STATE: WA ZIP: 98203 5 1 wf-form5_148357881449997.xml FORM 5 X0306 5 2016-12-31 0 0 0 0001659166 Fortive Corp FTV 0001670864 Pringle William W 6920 SEAWAY BLVD EVERETT WA 98203 0 1 0 0 Senior Vice President Executive Deferred Incentive Program - Fortive Stock Fund 0.0 2016-09-30 5 A 0 7.456 50.90 A Common Stock 7.456 5436.336 D Executive Deferred Incentive Program - Fortive Stock Fund 0.0 2016-12-30 5 A 0 7.086 53.63 A Common Stock 7.086 5436.336 D The reported securities are notional dividend accruals on phantom shares in the Fortive stock fund (the "EDIP Stock Fund") under Fortive's Executive Deferred Incentive Program (the "EDIP"). The number of phantom shares accrued as a result of such notional dividend accruals is based on the closing price of the Issuer's common stock as reported on the NYSE on the date such dividend accruals are credited to the EDIP Stock Fund, which is the price shown in Table II, Column 8 above. The notional shares convert on a one-to-one basis. The Reporting Person immediately vests in 100% of each voluntary contribution to the EDIP Stock Fund. The Reporting Person will vest in all contributions to the EDIP Stock Fund by the Issuer as follows: 100% upon the earlier of the Reporting Person's death, or upon retirement following at least 5 years of service with the Issuer and reaching the age of 55, or, if earlier, one-tenth per year of participation following five years of participation, in each case in accordance with the EDIP. Upon termination of employment, the vested portion of the EDIP Stock Fund is settled in the Issuer's common stock. Daniel B. Kim, as attorney-in-fact 2017-01-04