Initial Statement of Beneficial Ownership (3)
27 July 2016 - 7:10AM
Edgar (US Regulatory)
FORM 3
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES
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OMB APPROVAL
OMB Number:
3235-0104
Estimated average burden
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0.5
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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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1. Name and Address of Reporting Person
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Hussain Muhammad Raghib
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2. Date of Event Requiring Statement (MM/DD/YYYY)
7/22/2016
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3. Issuer Name
and
Ticker or Trading Symbol
CAVIUM, INC. [CAVM]
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(Last)
(First)
(Middle)
C/O CAVIUM, INC., 2315 N. FIRST STREET
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4. Relationship of Reporting Person(s) to Issuer (Check all applicable)
_____ Director
_____ 10% Owner
___
X
___ Officer (give title below)
_____ Other (specify below)
Chief Operating Officer /
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(Street)
SAN JOSE, CA 95131
(City)
(State)
(Zip)
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5. If Amendment, Date Original Filed
(MM/DD/YYYY)
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6. Individual or Joint/Group Filing
(Check Applicable Line)
_
X
_ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person
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Table I - Non-Derivative Securities Beneficially Owned
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1.Title of Security
(Instr. 4)
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2. Amount of Securities Beneficially Owned
(Instr. 4)
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3. Ownership Form: Direct (D) or Indirect (I)
(Instr. 5)
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4. Nature of Indirect Beneficial Ownership
(Instr. 5)
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Common stock
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277910
(1)
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D
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Common stock
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10000
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I
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Emaad Hussain 2007 Irrevocable Trust
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Common stock
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10000
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I
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Reja Raghib 2007 Irrevocable Trust
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Common stock
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10000
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I
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Zayaan Hussain Raghib Irrevocable Trust
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Table II - Derivative Securities Beneficially Owned (
e.g.
, puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security
(Instr. 4)
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2. Date Exercisable and Expiration Date
(MM/DD/YYYY)
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3. Title and Amount of Securities Underlying Derivative Security
(Instr. 4)
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4. Conversion or Exercise Price of Derivative Security
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5. Ownership Form of Derivative Security: Direct (D) or Indirect (I)
(Instr. 5)
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6. Nature of Indirect Beneficial Ownership
(Instr. 5)
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Date Exercisable
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Expiration Date
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Title
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Amount or Number of Shares
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Stock option (Right to Buy)
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(2)
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1/6/2017
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Common stock
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37500
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$24.16
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D
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Stock option (Right to Buy)
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(3)
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3/22/2020
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Common stock
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30000
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$37.63
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D
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Stock option (Right to Buy)
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(4)
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2/7/2021
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Common stock
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25000
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$37.83
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D
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Stock option (Right to Buy)
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(5)
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2/16/2022
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Common stock
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12886
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$62.86
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D
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Stock option (Right to Buy)
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(6)
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2/11/2023
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Common stock
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36181
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$48.88
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D
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Explanation of Responses:
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(
1)
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84,091 of these shares are Restricted Stock Units subject to vesting. On each vesting date, for each RSU vesting on such date, the reporting person will receive one share of Cavium's stock at no cost.
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(
2)
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Fully vested
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(
3)
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1/8th vest on date six months from March 22, 2013; remaining vest in 42 equal monthly increments.
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(
4)
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1/8th vest on date six months from February 7, 2014; remaining vest in 42 equal monthly increments.
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(
5)
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1/4th vest on February 16, 2016; remaining vest in 36 equal monthly increments.
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(
6)
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1/4th vest on February 11, 2017; remaining vest in 36 equal monthly increments.
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Reporting Owners
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Reporting Owner Name / Address
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Relationships
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Director
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10% Owner
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Officer
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Other
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Hussain Muhammad Raghib
C/O CAVIUM, INC.
2315 N. FIRST STREET
SAN JOSE, CA 95131
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Chief Operating Officer
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Signatures
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/s/ Muhammad Raghib Hussain
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7/26/2016
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**
Signature of Reporting Person
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Date
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
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*
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If the form is filed by more than one reporting person,
see
Instruction 5(b)(v).
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**
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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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Note:
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File three copies of this Form, one of which must be manually signed. If space is insufficient,
see
Instruction 6 for procedure.
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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.
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