Sec Form 4 Filing - Krause Thomas H. @ Broadcom Inc. - 2019-11-15

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
Krause Thomas H.
2. Issuer Name and Ticker or Trading Symbol
Broadcom Inc. [ AVGO]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
_____ Director _____ 10% Owner
X __ Officer (give title below) _____ Other (specify below)
Chief Financial Officer
(Last) (First) (Middle)
C/O BROADCOM INC., 1320 RIDDER PARK DRIVE
3. Date of Earliest Transaction (MM/DD/YY)
11/15/2019
(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
Common Stock, $0.001 par value 11/15/2019 M 2,500 ( 1 ) A $ 0 ( 2 ) 94,437 ( 3 ) D
Common Stock, $0.001 par value 11/15/2019 F 2,480 ( 4 ) D $ 312.91 91,957 ( 3 ) D
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
Performance Based Restricted Stock Units $ 0 11/15/2019 M 2,500 ( 1 ) ( 1 ) 11/15/2020 Common Stock, $0.001 par value 2,500 $ 0 2,500 D
Reporting Owners
Reporting Owner Name / Address Relationships
Director 10% Owner Officer Other
Krause Thomas H.
C/O BROADCOM INC.
1320 RIDDER PARK DRIVE
SAN JOSE, CA95131
Chief Financial Officer
Signatures
/s/Noelle Matteson, Attorney-in-Fact for Thomas H. Krause, Jr. 11/19/2019
Signature of Reporting Person Date
Explanation of Responses:
( 1 )Shares vested pursuant to a share price performance restricted share unit award (the "Performance RSU") granted pursuant to the Avago Technologies Limited 2009 Equity Incentive Award Plan on November 15, 2016. The Performance RSU is scheduled to vest over four years, with 25% vesting on each anniversary of the date of grant, such that the Performance RSU will be fully vested on November 15, 2020; provided, however, that no portion of the Performance RSU may vest unless the average of the closing prices of the Issuer's shares (as reported on the stock exchange on which the shares are listed), over a twenty consecutive trading day period is equal to or greater than 120% of the fair market value of the Issuer's shares on the date of grant (the "Price Contingency"). On February 13, 2017, the Price Contingency was met, and on November 15, 2019, the third 25% of the Performance RSU vested.
( 2 )Each Performance RSU represents the right to receive, at settlement, one share of common stock of the Issuer. This transaction represents the settlement of the Performance RSU in the Issuer's shares of common stock on the scheduled vesting date.
( 3 )Includes 63,500 Restricted Stock Units ("RSUs").
( 4 )Consists of shares of common stock withheld by the Issuer to satisfy the tax withholding obligations of the Reporting Person upon the vesting of the Performance RSU and the relevant RSUs previously granted to the Reporting Person.

Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
* If the form is filed by more than one reporting person, see Instruction 4(b)(v).
** Intentional misstatements or omissions of facts constitute Federal Criminal Violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a).

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