SEC Form 4 · accession 0001054374-15-000056

BROADCOM CORP · BRCM

Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗

Reporting owner

Henry Samueli

Officer — Chairman of the Board and CTO · Director

Period of report

Apr 15, 2015

Accepted (ET)

Apr 16, 2015 · 6:40 pm EDT

Rule 10b5-1 plan

unknown — predates the checkbox

Issuer CIK

0001054374

Table I — non-derivative securities

Security	Date	Code	Shares	Price	A/D	Owned after	D/I	Nature of ownership
Class A common stock^F2,F3	Apr 15, 2015	C	16,500	—	A	16,500	I	See Footnote
Class A common stock^F1	Apr 15, 2015	S	16,500	$45.00	D	0	I	See Footnote
Class A common stock^F2,F6	Apr 15, 2015	C	13,500	—	A	70,412	I	See Footnote
Class A common stock^F6,F5	Apr 15, 2015	S	13,500	$45.00	D	56,912	I	See Footnote
Class A common stock^F7	holding	—	—		—	602,183	D

Table II — derivative securities

Security	Conv. / exercise price	Date	Code	Shares	A/D	Exercisable	Expires	Underlying	Underlying shares	Owned after	D/I
Class B common stock^F3,F2	—	Apr 15, 2015	C	16,500	D	—	—	Class A common stock	16,500	14,106,992	I
Class B common stock^F6,F2	—	Apr 15, 2015	C	13,500	D	—	—	Class A common stock	13,500	6,608,025	I
Class B common stock^F8,F2	—	holding	—	—	—	—	—	Class A common stock	1,050,000	1,050,000	I
Class B common stock^F9,F2	—	holding	—	—	—	—	—	Class A common stock	913,473	913,473	I

Explanation of responses

F1Such transaction was effected by HS Portfolio L.P. The Reporting Person disclaims beneficial ownership of these securities except to the extent of his pecuniary interest therein.
F2Each share of Class B common stock is convertible at any time into one share of Class A common stock at the option of the holder.
F3Held by HS Portfolio L.P. The Reporting Person disclaims beneficial ownership of these securities except to the extent of his pecuniary interest therein.
F4The shares covered by this Form 4 are being sold pursuant to a Rule 10b5-1 Sales Plan, which is intended to comply with Rule 10b5-1 of the Securities Exchange Act of 1934, as amended.
F5Such transaction was effected by H&S Investments I L.P., an entity owned by the Shiloh Trust, for which trust the Reporting Person is co-trustee and co-beneficiary.
F6Held by H&S Investments I L.P., an entity owned by the Shiloh Trust, for which trust the Reporting Person is co-trustee and co-beneficiary.
F7Includes (i) 34,679 shares that are held as Class A common stock and (ii) 567,504 shares in the form of restricted stock units that will entitle the Reporting Person to receive one share of Class A common stock per restricted stock unit.
F8Held by H&S Portfolio II L.P., an entity owned by the Henry Samueli Lifetime Benefit Trust, for which trust the Reporting Person is trustee and beneficiary.
F9Held by HS Management, L.P. The Reporting Person disclaims beneficial ownership of these securities except to the extent of his pecuniary interest therein.