SEC Form 4 · accession 0001054374-15-000093

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

May 27, 2015

Accepted (ET)

May 29, 2015 · 5:42 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	May 27, 2015	C	16,500	—	A	16,500	I	See Footnote
Class A common stock^F1	May 27, 2015	S	16,500	$50.00	D	0	I	See Footnote
Class A common stock^F2,F3	May 27, 2015	C	462,000	—	A	462,000	I	See Footnote
Class A common stock^F1	May 27, 2015	S	462,000	$55.00	D	0	I	See Footnote
Class A common stock^F2,F6	May 27, 2015	C	13,500	—	A	70,412	I	See Footnote
Class A common stock^F5	May 27, 2015	S	13,500	$50.00	D	56,912	I	See Footnote
Class A common stock^F2,F6	May 27, 2015	C	321,088	—	A	378,000	I	See Footnote
Class A common stock^F5	May 27, 2015	S	378,000	$55.00	D	0	I	See Footnote
Class A common stock^F7	holding	—	—		—	578,738	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	—	May 27, 2015	C	478,500	D	—	—	Class A common stock	478,500	13,562,492	I
Class B common stock^F6,F2	—	May 27, 2015	C	334,588	D	—	—	Class A common stock	334,588	6,219,437	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) 56,152 shares that are held as Class A common stock and (ii) 522,586 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.