Edgar Filing: SAMUELI HENRY

Ownership Submission

FORM 5

	Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
	Form 3 Holdings Reported
	Form 4 Transactions Reported

UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
ANNUAL STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES

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.,Â 1320 RIDDER PARK DRIVE

3. Statement for Issuer's Fiscal Year Ended (Month/Day/Year)
10/29/2017

(Street)

SAN JOSE,Â CAÂ 95131

4. If Amendment, Date Original Filed(Month/Day/Year)
12/08/2017

6. Individual or Joint/Group Reporting
(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 (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 at end of Issuer's Fiscal Year (Instr. 3 and 4)	6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)	7. Nature of Indirect Beneficial Ownership (Instr. 4)
				Amount	(A) or (D)	Price

Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.

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 control number.

SEC 2270 (9-02)

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 Underlying Securities
(Instr. 3 and 4)

8. Price of Derivative Security
(Instr. 5)

9. Number of Derivative Securities Beneficially Owned at End of Issuer's Fiscal Year
(Instr. 4)

10. Ownership Form of Derivative Security: Direct (D) or Indirect (I)
(Instr. 4)

11. Nature of Indirect Beneficial Ownership
(Instr. 4)

(A)

(D)

Date Exercisable

Expiration Date

Title

Amount or Number of Shares

Exchangeable Units ⁽¹⁾ ⁽²⁾

04/10/2017

2,879

Â ⁽²⁾

Ordinary Shares, no par value

2,879

$ 0

2,879

See Footnote ⁽³⁾

Exchangeable Units ⁽¹⁾ ⁽²⁾

09/19/2017

G⁽⁴⁾

2,879

Â ⁽²⁾

Ordinary Shares, no par value

2,879

$ 0

See Footnote ⁽⁴⁾

Exchangeable Units ⁽¹⁾ ⁽²⁾

Â ⁽²⁾

Ordinary Shares, no par value

53,649

Exchangeable Units ⁽¹⁾ ⁽²⁾

Â ⁽²⁾

Ordinary Shares, no par value

40,058

See Footnote ⁽⁵⁾

Exchangeable Units ⁽¹⁾ ⁽²⁾

Â ⁽²⁾

Ordinary Shares, no par value

40,058

See Footnote ⁽⁶⁾

Exchangeable Units ⁽¹⁾ ⁽²⁾

Â ⁽²⁾

Ordinary Shares, no par value

5,752,978

See Footnote ⁽⁷⁾

Exchangeable Units ⁽¹⁾ ⁽²⁾

Â ⁽²⁾

Ordinary Shares, no par value

399,918

See Footnote ⁽⁸⁾

Exchangeable Units ⁽¹⁾ ⁽²⁾

Â ⁽²⁾

Ordinary Shares, no par value

459,690

See Footnote ⁽⁹⁾

Exchangeable Units ⁽¹⁾ ⁽²⁾

Â ⁽²⁾

Ordinary Shares, no par value

2,766,772

See Footnote ⁽¹⁰⁾

Exchangeable Units ⁽¹⁾ ⁽²⁾

Â ⁽²⁾

Ordinary Shares, no par value

1,860

See Footnote ⁽¹¹⁾

Reporting Owners

Reporting Owner Name / Address	Relationships
Reporting Owner Name / Address	Director	10% Owner	Officer	Other
SAMUELI HENRY C/O AVAGO TECHNOLOGIES US INC. 1320 RIDDER PARK DRIVE SAN JOSE,Â CAÂ 95131	Â X	Â	Â Chief Technical Officer	Â

Signatures

/s/ Noelle Matteson, Attorney-in-Fact for Henry Samueli		12/13/2017
^**Signature of Reporting Person		Date

Explanation of Responses:

*	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).
(1)	This amendment is being filed to remove the inadvertent inclusion of Exchangeable Units held by The Samueli 1995 Exempt Gifting Trust as the Reporting Person has no pecuniary interest in these securities.
(2)	Each Broadcom Cayman LP exchangeable unit ("the Exchangeable Unit") is convertible, at the holder'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.
(3)	Directly held by the Eisenberg 2005 Revocable Trust for which the Reporting Person's spouse is trustee and acquired dispositive power over these Exchangeable Units upon death of the initial trustee (the Reporting Person's mother-in-law).
(4)	Charitable gifts by the Eisenberg 2005 Revocable Trust.
(5)	Indirectly held by Henry Samueli 2016 GRAT through ownership of membership interests in HS REU, LLC, the direct holder of the Exchangeable Units.
(6)	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 Exchangeable Units. The Reporting Person disclaims beneficial ownership of these securities except to the extent of his pecuniary interest therein.
(7)	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.
(8)	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.
(9)	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.
(10)	Directly held by H&S Investments I L.P. and through its ownership of membership interests in HS REU, LLC and SFS REU, LLC, direct holders of certain Exchangeable Units. The Reporting Person disclaims beneficial ownership of these securities except to the extent of his pecuniary interest therein.
(11)	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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