Henry Samueli Form 4 Broadcom / HENRY SAMUELI ownership change

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^*

SAMUELI HENRY

(Last) (First) (Middle)

C/O AVAGO TECHNOLOGIES US INC.

1320 RIDDER PARK DRIVE

(Street)

SAN JOSE CA 95131

(City) (State) (Zip)

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

3. Date of Earliest Transaction (Month/Day/Year)
06/28/2017

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)
			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 (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)
				Code	V	(A)	(D)	Date Exercisable	Expiration Date	Title	Amount or Number of Shares
Exchangeable Units(1)	(1)	06/28/2017		P		62,010		(1)	(1)	Ordinary Shares, no par value	62,010	$235.72	40,058	I	See Footnote(2)
Exchangeable Units(1)	(1)	06/28/2017		P		62,010		(1)	(1)	Ordinary Shares, no par value	62,010	$235.72	40,058	I	See Footnote(3)
Exchangeable Units(1)	(1)							(1)	(1)	Ordinary Shares, no par value	53,649		53,649	D
Exchangeable Units(1)	(1)							(1)	(1)	Ordinary Shares, no par value	5,752,978		5,752,978	I	See Footnote(4)
Exchangeable Units(1)	(1)							(1)	(1)	Ordinary Shares, no par value	399,918		399,918	I	See Footnote(5)
Exchangeable Units(1)	(1)							(1)	(1)	Ordinary Shares, no par value	459,690		459,690	I	See Footnote(6)
Exchangeable Units(1)	(1)							(1)	(1)	Ordinary Shares, no par value	2,766,772		2,766,772	I	See Footnote(7)
Exchangeable Units(1)	(1)							(1)	(1)	Ordinary Shares, no par value	1,860		1,860	I	See Footnote(8)

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. Indirectly held by Henry Samueli 2016 GRAT through ownership of membership interests in HS REU, LLC, the direct holder of the Units. Number of Units adjusted to reflect change in the form of the Reporting Person's indirect ownership of 21,951.54 Units for no consideration, in transfer exempt from Section 16 of the Securities Exchange Act of 1934 pursuant to Rule 16a-13 thereunder.

3. Indirectly held by Susan Faye Samueli 2016 GRAT, a trust for the benefit of the Reporting Person's spouse, through ownership of membership interests in SFS REU, LLC, the direct holder of the Units. Number of Units adjusted to reflect change in the form of the Reporting Person's indirect ownership of 21,951.54 Units for no consideration, in transfer exempt from Section 16 of the Securities Exchange Act of 1934 pursuant to Rule 16a-13 thereunder. The Reporting Person disclaims beneficial ownership of these securities except to the extent of his pecuniary interest therein.

4. 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.

5. 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.

6. 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.

7. Directly held by H&S Investments I L.P. Number of Units adjusted to reflect change in the form of the Reporting Person's indirect ownership of 43,903.08 Units (directly held by HS REU LLC and SFS REU LLC) for no consideration, in transfers exempt from Section 16 of the Securities Exchange Act of 1934 pursuant to Rule 16a-13 thereunder. The Reporting Person disclaims beneficial ownership of these securities except to the extent of his pecuniary interest therein.

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.

	/s/ Anne G. Plimpton, Attorney-in-Fact for Henry Samueli	06/30/2017
	** Signature of Reporting Person	Date
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