SEC Filing | Broadcom Inc.

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SEC FORM 4 SEC Form 4

FORM 4

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
or Section 30(h) of the Investment Company Act of 1940

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Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).

1. Name and Address of Reporting Person^*

EGGEBRECHT LEWIS C

(Last)

(First)

(Middle)

C/O BROADCOM INC.

1320 RIDDER PARK DRIVE

(Street)

SAN JOSE

95131

(City)

(State)

(Zip)

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)

3. Date of Earliest Transaction (Month/Day/Year)
04/04/2018

4. If Amendment, Date of Original Filed (Month/Day/Year)

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. Transaction Date (Month/Day/Year)	2A. Deemed Execution Date, if any (Month/Day/Year)	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)
1. Title of Security (Instr. 3)	2. Transaction Date (Month/Day/Year)	2A. Deemed Execution Date, if any (Month/Day/Year)	Code	V	Amount	(A) or (D)	Price		6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)	7. Nature of Indirect Beneficial Ownership (Instr. 4)
Common Stock, $0.001 par value	04/04/2018		A		807⁽¹⁾	A	$0.00	6,833⁽²⁾	D
Common Stock, $0.001 par value								1,500	I	See Footnote⁽³⁾

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 (Month/Day/Year)	3A. Deemed Execution Date, if any (Month/Day/Year)	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 (Month/Day/Year)		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: Direct (D) or Indirect (I) (Instr. 4)	11. Nature of Indirect Beneficial Ownership (Instr. 4)
1. Title of Derivative Security (Instr. 3)	2. Conversion or Exercise Price of Derivative Security	3. Transaction Date (Month/Day/Year)	3A. Deemed Execution Date, if any (Month/Day/Year)	Code	V	(A)	(D)	Date Exercisable	Expiration Date	Title	Amount or Number of Shares	8. Price of Derivative Security (Instr. 5)		10. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)	11. Nature of Indirect Beneficial Ownership (Instr. 4)

Explanation of Responses:

1. Grant of Restricted Stock Units ("RSUs") pursuant to the Avago Technologies Limited 2009 Equity Incentive Award Plan. Upon vesting thereof, the Reporting Person is entitled to receive one (1) share of Issuer's common stock for each one (1) RSU. The Vesting Commencement Date is April 4, 2018. The RSUs vest in full on the earlier of (i) the first anniversary of the Vesting Commencement Date or (ii) the date on which the annual meeting of Issuer's stockholders immediately following the Vesting Commencement Date is held, subject to Reporting Person's continuing service on the vesting date.

2. Includes 807 restricted stock units.

3. Shares held by Lewis and Rebecca Eggebrecht Living Trust dated 6/21/1997 for which the Reporting Person serves as Trustee.

Remarks:

On April 4, 2018, Broadcom Inc., a Delaware corporation, became the successor of Broadcom Limited, a company organized under the laws of the Republic of Singapore ("Broadcom Limited"), pursuant to a scheme of arrangement under Singapore law under which all issued ordinary shares in the capital of Broadcom Limited were exchanged on a one-for-one basis for shares of common stock of Broadcom Inc. (the "Redomiciliation"). The Redomiciliation had the effect of changing Broadcom Limited's domicile, but did not alter the proportionate interests of shareholders.

	/s/ Noelle Matteson, Attorney-in-Fact for Lewis C. Eggebrecht	04/06/2018
	** Signature of Reporting Person	Date
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).
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure.
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number.

                               POWER OF ATTORNEY

        Know all by these presents, that the undersigned hereby constitutes and
appoints each of (i) the Chief Financial Officer of Broadcom Inc., a Delaware
corporation (the "Company"), and who is currently Thomas H. Krause, (ii) the
Company's Chief Legal Officer, who is currently Mark Brazeal, (iii) the
Company's Vice President of Human Resources, who is currently Debbie Streeter,
(iv) the Company's Deputy General Counsel, Corporate, who is currently Rebecca
Boyden, and (v) the Company's Associate General Counsel, Corporate & Securities,
who is currently Noelle Matteson, and their respective successors (including
anyone serving in such capacities on an interim or acting basis), signing
singly, with full powers of substitution, as the undersigned's true and lawful
attorney-in-fact to:

     1. prepare, execute in the undersigned's name and on the undersigned's
        behalf, and submit to the U.S. Securities and Exchange Commission (the
        "SEC") a Form ID, including amendments thereto, and any other documents
        necessary or appropriate to obtain codes and passwords enabling the
        undersigned to make electronic filings with the SEC of reports required
        by Section 16(a) of the Securities Exchange Act of 1934 or any rule or
        regulation of the SEC;

     2. execute for and on behalf of the undersigned, in the undersigned's
        capacity as an officer and/or director of the Company, and/or 10% holder
        of the Company's capital stock, Forms 3, 4, and 5 and any amendments
        thereto in accordance with Section 16(a) of the Securities Exchange Act
        of 1934 and the rules thereunder;

     3. do and perform any and all acts for and on behalf of the undersigned
        which may be necessary or desirable to complete and execute any such
        Form 3, 4, or 5, complete and execute any amendment or amendments
        thereto, and timely file such form with the SEC and any stock exchange
        or similar authority; and

     4. take any other action of any type whatsoever in connection with the
        foregoing which, in the opinion of such attorney-in-fact, may be of
        benefit to, in the best interest of, or legally required by, the
        undersigned, it being understood that the documents executed by such
        attorney-in-fact on behalf of the undersigned pursuant to this Power of
        Attorney shall be in such form and shall contain such terms and
        conditions as such attorney-in-fact may approve in such attorney-in-
        fact's discretion.

The undersigned hereby grants to each such attorney-in-fact full power and
authority to do and perform any and every act and thing whatsoever requisite,
necessary, or proper to be done in the exercise of any of the rights and powers
herein granted, as fully to all intents and purposes as the undersigned might or
could do if personally present, with full power of substitution or revocation,
hereby ratifying and confirming all that such attorney-in-fact, or such
attorney-in- fact's substitute or substitutes, shall lawfully do or cause to be
done by virtue of this power of attorney and the rights and powers herein
granted. The undersigned acknowledges that the foregoing attorneys-in-fact, in
serving in such capacity at the request of the undersigned, are not assuming,
nor is the Company assuming, any of the undersigned's responsibilities to comply
with Section 16 of the Securities Exchange Act of 1934.

        This Power of Attorney shall remain in full force and effect until the
undersigned is no longer required to file Forms 3, 4, and 5 with respect to the
undersigned's holdings of and transactions in securities issued by the Company,
unless earlier revoked by the undersigned in a signed writing delivered to the
foregoing attorneys-in-fact.

        IN WITNESS WHEREOF, the undersigned has caused this Power of Attorney to
be executed as of this 4th day of April , 2018.

                                         /s/ Lewis C. Eggebrecht
                                        ---------------------------------------
                                        By:  Lewis C. Eggebrecht