Statement of Changes in Beneficial Ownership (4)
March 04 2021 - 5:14PM
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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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
*
Krause Thomas H. |
2. Issuer Name and Ticker or Trading Symbol
Broadcom Inc.
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AVGO
]
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
_____ Director _____ 10% Owner
__X__ Officer (give title below) _____ Other (specify below)
President,Infrastructure SW Gp |
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(Last)
(First)
(Middle)
C/O BROADCOM INC., 1320 RIDDER PARK DRIVE |
3. Date of Earliest Transaction
(MM/DD/YYYY)
3/2/2021 |
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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
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Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
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1.Title of Security
(Instr. 3)
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2. Trans. Date
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2A. Deemed Execution Date, if any
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3. Trans. Code
(Instr. 8)
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4. Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
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5. Amount of Securities Beneficially Owned Following Reported Transaction(s)
(Instr. 3 and 4)
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6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)
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7. Nature of Indirect Beneficial Ownership (Instr. 4)
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Code
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V
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Amount
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(A) or (D)
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Price
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| Common Stock, $0.001 par value | 3/2/2021 | | A | | 2500 (1) | A | $0 | 48375 (2) | D | |
| Common Stock, $0.001 par value | 3/2/2021 | | A | | 2500 (3) | A | $0 | 50875 (4) | D | |
| Common Stock, $0.001 par value | 3/2/2021 | | A | | 2000 (5) | A | $0 | 52875 (6) | D | |
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) | On March 2, 2021, the Compensation Committee of the Issuer determined the achievement of certain performance criteria, based on the Issuer's compound annual total stockholder return ("TSR") 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 ("PSU award") granted on January 15, 2019 under the Avago Technologies Limited 2009 Equity Incentive Award Plan ("2009 Avago Plan"). The RSUs are subject to time-based vesting conditions and will vest in full on March 15, 2021, 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. |
| (2) | Represents 48,375 RSUs. |
| (3) | On March 2, 2021, the Compensation Committee of the Issuer determined the achievement of certain performance criteria, based on the Issuer's TSR relative to the S&P 500 Index, and the number of RSUs that will vest with respect to the second of four performance periods pursuant to the terms of a PSU award granted on January 15, 2019 under the 2009 Avago Plan. The RSUs are subject to time-based vesting conditions and will vest in full on March 15, 2021, 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. |
| (4) | Represents 50,875 RSUs. |
| (5) | On March 2, 2021, the Compensation Committee of the Issuer determined the achievement of certain performance criteria, based on the Issuer's TSR relative to the S&P 500 Index, and the number of RSUs that will vest with respect to the third of four performance periods pursuant to the terms of a PSU award granted on March 15, 2018 under the 2009 Avago Plan. The RSUs are subject to time-based vesting conditions and will vest in full on March 15, 2021, 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. |
| (6) | Represents 52,875 RSUs. |
Reporting Owners
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| Reporting Owner Name / Address | Relationships |
| Director | 10% Owner | Officer | Other |
Krause Thomas H.
C/O BROADCOM INC.
1320 RIDDER PARK DRIVE
SAN JOSE, CA 95131 |
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| President,Infrastructure SW Gp |
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Signatures
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| /s/Noelle Matteson, Attorney-in-Fact for Thomas H. Krause, Jr. | | 3/4/2021 |
| **Signature of Reporting Person | Date |
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