Fortive Corporation
12/01/2021 | Press release | Distributed by Public on 12/01/2021 15:13
Statement of Changes in Beneficial Ownership (Form 4)
Ownership Submission
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
(e.g., puts, calls, warrants, options, convertible securities)
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, See Instruction 6 for procedure.Potential persons who are to respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB number.
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FORM 4
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 or Section 30(h) of the Investment Company Act of 1940 |
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(e.g., puts, calls, warrants, options, convertible securities)
| 1. Title of Derivate Security | 2. Conversion or Exercise Price of Derivative Security | 3. Transaction Date (Month/Day/Year) | 3A. Deemed Execution Date, if any (Month/Day/Year) | 4. Transaction Code | 5. Number of Derivative Securities Acquired (A) or Disposed of (D) | 6. Date Exercisable and Expiration Date | 7. Title and Amount of Securities Underlying Derivative Security | 8. Price of Derivative Security | 9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) | 10. Ownership Form of Derivative Security: Direct (D) or Indirect (I) | 11. Nature of Indirect Beneficial Ownership |
| Code | V | (A) | (D) | Date Exercisable | Expriation Date | Title | Amount or Number of Shares |
Reporting Owners
| Reporting Owner Name / Address | Relationships | |||
| Director | 10% Owner | Officer | Other | |
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Hulit Barbara B. 6920 SEAWAY BLVD EVERETT, WA98203 |
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President & CEO of AHS |
Signatures
| Daniel B. Kim, as attorney-in-fact | 2021-12-01 |
| **Signature of Reporting Person | Date |
Explanation of Responses:
| (*) | If the form is filed by more than one reporting person, see Instruction 5(b)(v). |
| (**) | Intentional misstatements or omissions of facts constitute Federal Criminal Violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). |
| (1) | The transaction was effectuated pursuant to a Rule 10b5-1 trading plan. |
| (2) | The price reported in Table I, Column 4 is a weighted average price. These shares were sold in multiple transactions at prices ranging from $76.000 to $76.395. The Reporting Person undertakes to provide to the Issuer, any security holder of Issuer, or the staff of the Securities and Exchange Commission, upon request, full information regarding the number of shares sold at each separate price within the range set forth herein. |
| (3) | Prior to the separation of the Issuer from Danaher Corporation ("Danaher") on July 2, 2016 (the "Separation"), the stock options issued by Danaher on February 21, 2013 ("2013 Danaher Options") to the Reporting Person became exercisable ratably on third, fourth and fifth anniversary of the grant date. In connection with the Separation, the 2013 Danaher Options that remained unexercised as of July 2, 2016 were converted into stock options to purchase 46,609 shares of the Issuer's common stock with identical vesting schedule. In addition, the total number of stock options and the exercise price reflect an anti-dilution adjustment applied as a result of the spin-off of Vontier Corporation from the Issuer on October 9, 2020. |
| (4) | Prior to the Separation, the stock options issued by Danaher on February 24, 2014 ("February 2014 Danaher Options") to the Reporting Person became exercisable ratably on third, fourth and fifth anniversary of the grant date. In connection with the Separation, the February 2014 Danaher Options that remained unexercised as of July 2, 2016 were converted into stock options to purchase 37,591 shares of the Issuer's common stock with identical vesting schedule. In addition, the total number of stock options and the exercise price reflect an anti-dilution adjustment applied as a result of the spin-off of Vontier Corporation from the Issuer on October 9, 2020. |
| (5) | Prior to the Separation, the stock options issued by Danaher on May 15, 2014 ("May 2014 Danaher Options") to the Reporting Person became exercisable ratably on third, fourth and fifth anniversary of the grant date. In connection with the Separation, the May 2014 Danaher Options that remained unexercised as of July 2, 2016 were converted into stock options to purchase 17,381 shares of the Issuer's common stock with identical vesting schedule. In addition, the total number of stock options and the exercise price reflect an anti-dilution adjustment applied as a result of the spin-off of Vontier Corporation from the Issuer on October 9, 2020. |
| (6) | Prior to the Separation, the stock options issued by Danaher on February 24, 2015 ("2015 Danaher Options") to the Reporting Person became exercisable ratably on third, fourth and fifth anniversary of the grant date. In connection with the Separation, the 2015 Danaher Options that remained unexercised as of July 2, 2016 were converted into stock options to purchase 39,989 shares of the Issuer's common stock with identical vesting schedule. In addition, the total number of stock options and the exercise price reflect an anti-dilution adjustment applied as a result of the spin-off of Vontier Corporation from the Issuer on October 9, 2020. |