Sec Form 4 Filing - BELK JOHN R @ BELK INC - 2015-10-29

Insider filing report for Changes in Beneficial Ownership
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FORM 4
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP
Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(h) of the Investment Company Act of 1940
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1. Name and Address of Reporting Person
BELK JOHN R
2. Issuer Name and Ticker or Trading Symbol
BELK INC [ NONE]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X __ Director X __ 10% Owner
X __ Officer (give title below) _____ Other (specify below)
President & COO
(Last) (First) (Middle)
2801 WEST TYVOLA ROAD
3. Date of Earliest Transaction (MM/DD/YY)
10/29/2015
(Street)
CHARLOTTE, NC28217-4500
4. If Amendment, Date Original Filed (MM/DD/YY)
6. Individual or Joint/Group Filing (Check Applicable Line)
__ X __ Form filed by One Reporting Person
_____ Form filed by More than One Reporting Person
(City) (State) (Zip)
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
1.Title of Security
(Instr. 3)
2. Transaction Date (MM/DD/YY) 2A. Deemed Execution Date, if any (MM/DD/YY) 3. Transaction Code
(Instr. 8)
4. Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
5. Amount of Securities Beneficially Owned Following Reported Transaction(s)
(Instr. 3 and 4)
6. Ownership Form: Direct (D) or Indirect (I)
(Instr. 4)
7. Nature of Indirect Beneficial Ownership
(Instr. 4)
Code V Amount (A) or (D) Price
Class A Common Stock 10/29/2015 J 6,348 ( 1 ) A $ 0 359,722 ( 2 ) D
Class A Common Stock 154,543 ( 3 ) I Trustee GRAT #1
Class A Common Stock 10/29/2015 J 211,389 ( 4 ) D $ 0 0 I Trustee GRAT #2
Class A Common Stock 146,809 ( 5 ) I Trustee GRAT #3
Class A Common Stock 191,932 ( 6 ) I Spouse
Class A Common Stock 402,284 ( 7 ) I Trustee
Class A Common Stock 1,221,842 ( 8 ) I Brothers Investment Company
Class A Common Stock 444,212 ( 9 ) I Milburn Investment Company
Class A Common Stock 228,016 ( 10 ) I Trustee
Class A Common Stock 10/29/2015 J 68,347 ( 11 ) A $ 0 258,611 ( 12 ) I Trustee
Class A Common Stock 10/29/2015 J 68,347 ( 13 ) A $ 0 258,612 ( 14 ) I Trustee
Class A Common Stock 10/29/2015 J 68,347 ( 15 ) A $ 0 258,612 ( 16 ) I Trustee
Class A Common Stock 183,825 ( 17 ) I Trusts, spouse and child are trustees
Class A Common Stock 14,250 ( 18 ) I Trustee, Family Wealth Preservation Trust
Class B Common Stock 21,810 ( 19 ) D
Class B Common Stock 9,542 ( 20 ) I Trustee
Class B Common Stock 9,541 ( 21 ) I Trustee
Class B Common Stock 9,541 ( 22 ) I Trustee
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
( e.g. , puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security
(Instr. 3)
2. Conversion or Exercise Price of Derivative Security 3. Transaction Date (MM/DD/YY) 3A. Deemed Execution Date, if any (MM/DD/YY) 4. Transaction Code
(Instr. 8)
5. Number of Derivative Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4, and 5)
6. Date Exercisable and Expiration Date
(MM/DD/YY)
7. Title and Amount of Underlying Securities
(Instr. 3 and 4)
8. Price of Derivative Security
(Instr. 5)
9. Number of Derivative Securities Beneficially Owned Following Reported Transaction(s)
(Instr. 4)
10. Ownership Form of Derivative Security: Direct (D) or Indirect (I)
(Instr. 4)
11. Nature of Indirect Beneficial Ownership
(Instr. 4)
Code V (A) (D) Date Exercisable Expiration Date Title Amount or Number of Shares
Reporting Owners
Reporting Owner Name / Address Relationships
Director 10% Owner Officer Other
BELK JOHN R
2801 WEST TYVOLA ROAD
CHARLOTTE, NC28217-4500
X X President & COO
Signatures
John R. Belk by Holly C. Williamson, POA 11/02/2015
Signature of Reporting Person Date
Explanation of Responses:
( 1 )6,348 shares of Class A common stock were received by Reporting Person from John R. Belk Grantor Retained Annuity Trust dated October 12, 2009.
( 2 )359,722 shares of Class A common stock are held in Reporting Person's name and/or John Robert Belk, Trustee U/A dated 1/17/94, Reporting Person's grantor trust.
( 3 )154,543 shares of Class A common stock are held by John R. Belk Grantor Retained Annuity Trust dated January 23, 2006. Reporting Person is the Trustee.
( 4 )211,389 shares of Class A common stock were distributed by John R. Belk Grantor Retained Annuity Trust dated October 12, 2009 as the final distribution. 6,348 shares of Class A common stock were distributed to the Grantor, and 205,041 shares of Class A common stock were distributed to the beneficiaries. Reporting Person is the Trustee.
( 5 )146,809 shares of Class A common stock are held by John R. Belk Grantor Retained Annuity Trust dated October 22, 2010. Reporting Person is the Trustee.
( 6 )191,932 shares of Class A common stock are held by Kimberly D. Belk, Reporting Person's spouse, or by her grantor trust, Kimberly Dupree Belk Revocable Trust dated July 27, 2007.
( 7 )402,284 shares of Class A common stock are held by Katherine McKay Belk Irrevocable Trust dated November 6, 2000. Voting and investment power is shared by Katherine McKay Belk, Thomas M. Belk, Jr., H.W. McKay Belk, John R. Belk and Katherine Belk Morris.
( 8 )1,221,842 shares of Class A common stock are held by Brothers Investment Company, which corporation is equally owned by John M. Belk QTIP GST Non-Exempt Marital Trust, Wells Fargo Bank, N.A., Susan N. Jamison and Katherine B. Morris, Co-Trustees ("John M. Belk QTIP GST Non-Exempt Marital Trust") and the heirs of Thomas M. Belk. The co-trustees of John M. Belk QTIP GST Non-Exempt Marital Trust and Katherine McKay Belk, Thomas M. Belk, Jr., H.W. McKay Belk, John R. Belk and Katherine Belk Morris, heirs of Thomas M. Belk, share voting and investment power.
( 9 )444,212 shares of Class A common stock are held by Milburn Investment Company. Voting and investment power is shared by Katherine McKay Belk, Thomas M. Belk, Jr., H.W. McKay Belk, John R. Belk and Katherine Belk Morris.
( 10 )228,016 Class A shares held in a trust established by the Will of W.H. Belk for the benefit of Thomas M. Belk. Sarah Belk Gambrell, Katherine Belk Morris, Thomas M. Belk, Jr., H.W. McKay Belk and John R. Belk, the trustees, share voting and investment power.
( 11 )68,347 shares Class A common stock were received by the trustees of the Anna Dupree Belk Irrevocable Trust dated May 28, 2010 as a transfer from Anna Dupree Belk who received the shares as a distribution from John R. Belk Grantor Retained Annuity Trust dated October 12, 2009. Reporting Person is a trustee of this trust.
( 12 )258,611 shares of Class A common stock are held by Anna Dupree Belk Irrevocable Trust dated May 28, 2010. Voting and investment power is shared by Anna Dupree Belk, John R. Belk and Kimberly D. Belk, the trustees.
( 13 )68,347 shares Class A common stock were received by the trustees of the John Robert Belk, Jr. Irrevocable Trust dated August 11, 2011 as a transfer from John Robert Belk, Jr. who received the shares as a distribution from John R. Belk Grantor Retained Annuity Trust dated October 12, 2009. Reporting Person is a trustee of this trust.
( 14 )258,612 shares of Class A common stock are held by John Robert Belk, Jr. Irrevocable Trust dated August 11, 2011. Voting and investment power is shared by John Robert Belk, Jr., John R. Belk and Kimberly D. Belk, the trustees
( 15 )68,347 shares Class A common stock were received by the trustees of the Frances Whitner Belk Irrevocable Trust dated August 18, 2014 as a transfer from Frances Whitner Belk who received the shares as a distribution from John R. Belk Grantor Retained Annuity Trust dated October 12, 2009. Reporting Person is a trustee of this trust.
( 16 )258,612 shares of Class A common stock are held by Frances Whitner Belk Irrevocable Trust dated August 18, 2014. Voting and investment power is shared by Frances Whitner Belk, John R. Belk and Kimberly D. Belk, the trustees.
( 17 )61,275 shares of Class A common stock are held by each of the following trusts: John R. Belk & Kimberly D. Belk Family Wealth Preservation Trust dated December 21, 2012, f/b/o Anna Dupree Belk; John R. Belk & Kimberly D. Belk Family Wealth Preservation Trust dated December 21, 2012, f/b/o John Robert Belk, Jr.; and John R. Belk & Kimberly D. Belk Family Wealth Preservation Trust dated December 21, 2012, f/b/o Frances Whitner Belk. Kimberly D. Belk, Reporting Person's wife, and the child that is beneficiary of the trust are trustees of each trust.
( 18 )14,250 shares of Class A common stock are held by The Katherine McKay Belk FWP Trust f/b/o John R. Belk Descendants dated June 3, 2015. Reporting Person is the Trustee.
( 19 )10,648 shares of Class B common stock are held in Reporting Person's name and/or John Robert Belk, Trustee U/A dated 1/17/94, Reporting Person's grantor trust. 11,162 of the shares from the Belk, Inc. Executive Long Term Incentive Compensation Plan XV are not payable to the Reporting Person until 2016.
( 20 )9,542 shares of Class B common stock are held by Anna Dupree Belk Irrevocable Trust dated May 28, 2010. Voting and investment power is shared by Anna Dupree Belk, John R. Belk and Kimberly D. Belk, the trustees.
( 21 )9,541 shares of Class B common stock are held by John Robert Belk, Jr. Irrevocable Trust dated August 11, 2011. Voting and investment power is shared by John Robert Belk, Jr., John R. Belk and Kimberly D. Belk, the trustees
( 22 )9,541 shares of Class B common stock are held by Frances Whitner Belk Irrevocable Trust dated August 18, 2014. Voting and investment power is shared by Frances Whitner Belk, John R. Belk and Kimberly D. Belk, the trustees.

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