SEC Form 4 · accession 0001730168-19-000026
Broadcom Inc. · AVGO
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Henry Samueli
Director
Period of report
Mar 4, 2019
Accepted (ET)
Mar 6, 2019 · 9:00 pm EST
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0001730168
Table I — non-derivative securities
| Security | Date | Code | Shares | Price | A/D | Owned after | D/I | Nature of ownership |
|---|---|---|---|---|---|---|---|---|
| Common Stock, $0.001 par valueF1,F2 | Mar 4, 2019 | A | 500 | $0.00 | A | 254,838 | D | |
| Common Stock, $0.001 par valueF3 | holding | — | — | — | 2,815,759 | I | See Footnote | |
| Common Stock, $0.001 par valueF4 | holding | — | — | — | 5,752,978 | I | See Footnote | |
| Common Stock, $0.001 par valueF5 | holding | — | — | — | 399,918 | I | See Footnote | |
| Common Stock, $0.001 par valueF6 | holding | — | — | — | 459,690 | I | See Footnote | |
| Common Stock, $0.001 par valueF7 | holding | — | — | — | 1,860 | I | See Footnote |
Table II — derivative securities
No Table II lines on this filing.
Explanation of responses
- F1On March 4, 2019, the Compensation Committee of the Issuer determined the achievement of certain performance criteria, based on the Issuer's compound annual total stockholder return relative to the S&P 500 Index, and the number of restricted stock units ("RSUs") that will vest with respect to the first of four performance periods pursuant to the terms of a performance stock unit award granted on March 15, 2018 under the Broadcom Corporation 2012 Stock Incentive Plan. The RSUs are subject to time-based vesting conditions and will vest in full on March 15, 2019, subject to the Reporting Person's continued service through such date. Upon vesting thereof, the Reporting Person is entitled to one (1) share of common stock for each one (1) RSU.
- F2Includes 30,877 RSUs.
- F3Directly held by H&S Investments I L.P. The Reporting Person disclaims beneficial ownership of these securities except to the extent of his pecuniary interest therein.
- F4Directly held by HS Portfolio L.P. The Reporting Person disclaims beneficial ownership of these securities except to the extent of his pecuniary interest therein.
- F5Directly held by HS Management, L.P. The Reporting Person disclaims beneficial ownership of these securities except to the extent of his pecuniary interest therein.
- F6Directly held by H&S Portfolio II L.P. The Reporting Person disclaims beneficial ownership of these securities except to the extent of his pecuniary interest therein.
- F7Directly held by H&S Ventures LLC. The Reporting Person disclaims beneficial ownership of these securities except to the extent of his pecuniary interest therein.