Sec Form 4 Filing - SAMUELI HENRY @ Broadcom Ltd - 2017-06-06

Insider filing report for Changes in Beneficial Ownership
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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
Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(h) of the Investment Company Act of 1940
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1. Name and Address of Reporting Person
SAMUELI HENRY
2. Issuer Name and Ticker or Trading Symbol
Broadcom Ltd [ AVGO]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X __ Director _____ 10% Owner
X __ Officer (give title below) _____ Other (specify below)
Chief Technical Officer
(Last) (First) (Middle)
C/O AVAGO TECHNOLOGIES US INC., 1320 RIDDER PARK DRIVE
3. Date of Earliest Transaction (MM/DD/YY)
06/06/2017
(Street)
SAN JOSE, CA95131
4. If Amendment, Date Original Filed (MM/DD/YY)
6. Individual or Joint/Group Filing (Check Applicable Line)
__ X __ Form filed by One Reporting Person
_____ Form filed by More than One Reporting Person
(City) (State) (Zip)
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
1.Title of Security
(Instr. 3)
2. Transaction Date (MM/DD/YY) 2A. Deemed Execution Date, if any (MM/DD/YY) 3. Transaction 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
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
( e.g. , puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security
(Instr. 3)
2. Conversion or Exercise Price of Derivative Security 3. Transaction Date (MM/DD/YY) 3A. Deemed Execution Date, if any (MM/DD/YY) 4. Transaction 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
(MM/DD/YY)
7. Title and Amount of Underlying Securities
(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
Exchangeable Units ( 1 ) ( 1 ) ( 1 ) ( 1 ) Ordinary Shares, no par value 53,649 53,649 D
Exchangeable Units ( 1 ) ( 1 ) 06/06/2017 J( 6 ) 182,820 ( 1 ) ( 1 ) Ordinary Shares, no par value 5,752,978 ( 7 ) $ 0 5,752,978 ( 7 ) I See Footnote ( 2 )
Exchangeable Units ( 1 ) ( 1 ) ( 1 ) ( 1 ) Ordinary Shares, no par value 399,918 399,918 I See Footnote ( 3 )
Exchangeable Units ( 1 ) ( 1 ) ( 1 ) ( 1 ) Ordinary Shares, no par value 459,690 459,690 I See Footnote ( 4 )
Exchangeable Units ( 1 ) ( 1 ) ( 1 ) ( 1 ) Ordinary Shares, no par value 2,722,869 2,722,869 I See Footnote ( 5 )
Exchangeable Units ( 1 ) ( 1 ) ( 1 ) ( 1 ) Ordinary Shares, no par value 1,860 ( 7 ) 1,860 ( 7 ) I See Footnote ( 8 )
Reporting Owners
Reporting Owner Name / Address Relationships
Director 10% Owner Officer Other
SAMUELI HENRY
C/O AVAGO TECHNOLOGIES US INC.
1320 RIDDER PARK DRIVE
SAN JOSE, CA95131
X Chief Technical Officer
Signatures
/s/ Anne G. Plimpton, Attorney-in-Fact for Henry Samueli 06/08/2017
Signature of Reporting Person Date
Explanation of Responses:
( 1 )Each Broadcom Cayman LP exchangeable unit is convertible, at the Reporting Person's election, at any time after February 1, 2017, into ordinary shares of the Issuer or a cash amount equal to a prescribed cash amount determined by reference to the weighted average trading price of the Issuer's ordinary shares on NASDAQ for the trading day ending on the last business day prior to the date on which an exchange notice is delivered, at the sole discretion of the Issuer, as the general partner of Broadcom Cayman LP. This conversion right has no expiration date.
( 2 )Directly held by HS Portfolio L.P. The Reporting Person disclaims beneficial ownership of these securities except to the extent of his pecuniary interest therein.
( 3 )Directly held by HS Management, L.P. The Reporting Person disclaims beneficial ownership of these securities except to the extent of his pecuniary interest therein.
( 4 )Directly 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.
( 5 )Directly 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.
( 6 )Distribution to partners other than the Reporting Person of Exchangeable Units in which the Reporting Person had no pecuniary interest.
( 7 )Reflects change in the form of the Reporting Person's indirect ownership of 1,860 Exchangeable Units for no consideration in transfer exempt from Section 16 of the Securities Exchange Act of 1934 pursuant to Rule 16a-13 thereunder.
( 8 )Directly held by H&S Ventures LLC. The Reporting Person disclaims beneficial ownership of these securities except to the extent of his pecuniary interest therein.

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