Statement of Changes in Beneficial Ownership (4)
January 14 2021 - 04:45PM
Edgar (US Regulatory)
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 OF SECURITIES
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APPROVAL
OMB Number: 3235-0287
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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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1. Name
and Address of Reporting Person *
HARTENSTEIN EDDY W |
2. Issuer Name and Ticker or Trading
Symbol Broadcom Inc. [ AVGO ] |
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)__X__
Director _____
10% Owner
_____ Officer (give title
below) _____ Other
(specify below)
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(Last)
(First)
(Middle)
C/O BROADCOM INC., 1320 RIDDER PARK DRIVE |
3. Date of Earliest Transaction (MM/DD/YYYY)
1/12/2021
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(Street)
SAN JOSE, CA 95131
(City)
(State)
(Zip)
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4. If Amendment, Date Original Filed
(MM/DD/YYYY)
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6. Individual or Joint/Group Filing
(Check Applicable Line) _X _ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person |
Table I - Non-Derivative Securities Acquired, Disposed of, or
Beneficially Owned
|
1.Title of Security
(Instr. 3) |
2. Trans. Date |
2A. Deemed Execution Date, if any |
3. Trans. 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 |
Common Stock, $0.001 par
value |
1/12/2021 |
|
S(1) |
|
98 |
D |
$447.723 (2) |
11562 (3) |
D |
|
Common Stock, $0.001 par
value |
1/12/2021 |
|
S(1) |
|
84 |
D |
$449.008 (4) |
11478 (3) |
D |
|
Common Stock, $0.001 par
value |
1/12/2021 |
|
S(1) |
|
222 |
D |
$449.922 (5) |
11256 (3) |
D |
|
Common Stock, $0.001 par
value |
1/12/2021 |
|
S(1) |
|
96 |
D |
$450.974 (6) |
11160 (3) |
D |
|
Common Stock, $0.001 par
value |
1/12/2021 |
|
S(1) |
|
30 |
D |
$452.67 |
11130 (3) |
D |
|
Common Stock, $0.001 par
value |
1/13/2021 |
|
S(1) |
|
104 |
D |
$449.38 (7) |
11026 (3) |
D |
|
Common Stock, $0.001 par
value |
1/13/2021 |
|
S(1) |
|
284 |
D |
$450.839 (8) |
10742 (3) |
D |
|
Common Stock, $0.001 par
value |
1/13/2021 |
|
S(1) |
|
112 |
D |
$451.714 (9) |
10630 (3) |
D |
|
Common Stock, $0.001 par
value |
1/13/2021 |
|
S(1) |
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30 |
D |
$452.46 |
10600 (3) |
D |
|
Common Stock, $0.001 par
value |
|
|
|
|
|
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22892 |
I |
See Footnote (10) |
Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible
securities)
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1. Title of Derivate Security
(Instr. 3) |
2. Conversion or Exercise Price of Derivative
Security |
3. Trans. Date |
3A. Deemed Execution Date, if any |
4. Trans. 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 |
7. Title and Amount of Securities Underlying
Derivative Security
(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 |
Explanation of
Responses: |
(1) |
Transaction made pursuant to
a Rule 10b5-1 trading plan adopted by the Reporting
Person. |
(2) |
Transaction executed in
multiple trades at prices ranging from $447.30 to $448.01 per
share, inclusive. The price reported in column 4 above reflects the
weighted average sale price per share. The Reporting Person hereby
undertakes to provide the SEC staff, the Issuer or a security
holder of the Issuer, upon request, full information regarding the
number of shares sold at each respective price within the range set
forth in this footnote. |
(3) |
Includes 949 restricted
stock units. |
(4) |
Transaction executed in
multiple trades at prices ranging from $448.41 to $449.38 per
share, inclusive. The price reported in column 4 above reflects the
weighted average sale price per share. The Reporting Person hereby
undertakes to provide the SEC staff, the Issuer or a security
holder of the Issuer, upon request, full information regarding the
number of shares sold at each respective price within the range set
forth in this footnote. |
(5) |
Transaction executed in
multiple trades at prices ranging from $449.41 to $450.35 per
share, inclusive. The price reported in column 4 above reflects the
weighted average sale price per share. The Reporting Person hereby
undertakes to provide the SEC staff, the Issuer or a security
holder of the Issuer, upon request, full information regarding the
number of shares sold at each respective price within the range set
forth in this footnote. |
(6) |
Transaction executed in
multiple trades at prices ranging from $450.48 to $451.33 per
share, inclusive. The price reported in column 4 above reflects the
weighted average sale price per share. The Reporting Person hereby
undertakes to provide the SEC staff, the Issuer or a security
holder of the Issuer, upon request, full information regarding the
number of shares sold at each respective price within the range set
forth in this footnote. |
(7) |
Transaction executed in
multiple trades at prices ranging from $449.19 to $449.96 per
share, inclusive. The price reported in column 4 above reflects the
weighted average sale price per share. The Reporting Person hereby
undertakes to provide the SEC staff, the Issuer or a security
holder of the Issuer, upon request, full information regarding the
number of shares sold at each respective price within the range set
forth in this footnote. |
(8) |
Transaction executed in
multiple trades at prices ranging from $450.31 to $451.22 per
share, inclusive. The price reported in column 4 above reflects the
weighted average sale price per share. The Reporting Person hereby
undertakes to provide the SEC staff, the Issuer or a security
holder of the Issuer, upon request, full information regarding the
number of shares sold at each respective price within the range set
forth in this footnote. |
(9) |
Transaction executed in
multiple trades at prices ranging from $451.32 to $452.19 per
share, inclusive. The price reported in column 4 above reflects the
weighted average sale price per share. The Reporting Person hereby
undertakes to provide the SEC staff, the Issuer or a security
holder of the Issuer, upon request, full information regarding the
number of shares sold at each respective price within the range set
forth in this footnote. |
(10) |
Shares held by the
Hartenstein family trust, for which the Reporting Person serves as
trustee. |
Reporting
Owners
|
Reporting Owner Name / Address |
Relationships
|
Director |
10% Owner |
Officer |
Other |
HARTENSTEIN EDDY W
C/O BROADCOM INC.
1320 RIDDER PARK DRIVE
SAN JOSE, CA 95131 |
X |
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Signatures
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/s/ Noelle Matteson, Attorney-in-Fact for Eddy W.
Hartenstein |
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1/14/2021 |
**Signature of
Reporting Person |
Date |