Statement of Changes in Beneficial Ownership (4)
April 08 2021 - 06:54PM
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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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
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HARTENSTEIN EDDY W |
2. Issuer Name and Ticker or Trading Symbol
Broadcom Inc.
[
AVGO
]
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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)
4/6/2021 |
(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 | 4/6/2021 | | S(1) | | 101 | D | $482.054 (2) | 5675 (3) | D | |
Common Stock, $0.001 par value | 4/6/2021 | | S(1) | | 132 | D | $483.228 (4) | 5543 (3) | D | |
Common Stock, $0.001 par value | 4/6/2021 | | S(1) | | 130 | D | $484.467 (5) | 5413 (3) | D | |
Common Stock, $0.001 par value | 4/6/2021 | | S(1) | | 91 | D | $486.159 (6) | 5322 (3) | D | |
Common Stock, $0.001 par value | 4/6/2021 | | S(1) | | 76 | D | $487.451 (7) | 5246 (3) | D | |
Common Stock, $0.001 par value | 4/7/2021 | | S(1) | | 107 | D | $479.028 (8) | 5139 (3) | D | |
Common Stock, $0.001 par value | 4/7/2021 | | S(1) | | 162 | D | $479.98 (9) | 4977 (3) | D | |
Common Stock, $0.001 par value | 4/7/2021 | | S(1) | | 34 | D | $481.379 (10) | 4943 (3) | D | |
Common Stock, $0.001 par value | 4/7/2021 | | S(1) | | 154 | D | $482.077 (11) | 4789 (3) | D | |
Common Stock, $0.001 par value | 4/7/2021 | | S(1) | | 73 | D | $483.078 (12) | 4716 (3) | D | |
Common Stock, $0.001 par value | | | | | | | | 22892 (13) | I | See Footnote |
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 $481.61 to $482.60 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 476 restricted stock units. |
(4) | Transaction executed in multiple trades at prices ranging from $482.66 to $483.62 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 $484.20 to $484.78 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 $485.78 to $486.37 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 $487.14 to $487.70 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 $478.41 to $479.35 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. |
(9) | Transaction executed in multiple trades at prices ranging from $479.55 to $480.50 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) | Transaction executed in multiple trades at prices ranging from $480.63 to $481.62 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. |
(11) | Transaction executed in multiple trades at prices ranging from $481.63 to $482.61 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. |
(12) | Transaction executed in multiple trades at prices ranging from $482.65 to $483.49 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. |
(13) | Shares held by the Hartenstein family trust, for which the Reporting Person serves as trustee. |
Reporting Owners
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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 | | 4/8/2021 |
**Signature of Reporting Person | Date |
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