Statement of Changes in Beneficial Ownership (4)
November 23 2021 - 04:10PM
Edgar (US Regulatory)
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 OF SECURITIES
|
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OMB Number: 3235-0287
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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
|
|
1. Name
and Address of Reporting Person * Palkhiwala Akash
J. |
2. Issuer Name and Ticker or Trading
Symbol QUALCOMM INC/DE [ QCOM ] |
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)
5775 MOREHOUSE DR. |
3. Date of Earliest Transaction (MM/DD/YYYY)
11/20/2021
|
(Street)
SAN DIEGO, CA 92121-1714
(City)
(State)
(Zip)
|
4. If Amendment, Date Original Filed
(MM/DD/YYYY)
|
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. Trans. Date |
2A. Deemed Execution Date, if any |
3. Trans. 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 |
11/20/2021 |
|
M |
|
2384 |
A |
$0.0 |
47178 |
D |
|
Common Stock |
11/20/2021 |
|
M |
|
1933 |
A |
$0.0 |
49111 |
D |
|
Common Stock |
11/20/2021 |
|
F |
|
1182 |
D |
$185.0 |
47929 |
D |
|
Common Stock |
11/20/2021 |
|
F |
|
959 |
D |
$185.0 |
46970 |
D |
|
Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible
securities)
|
1. Title of Derivate Security
(Instr. 3) |
2. Conversion or Exercise Price of Derivative
Security |
3. Trans. Date |
3A. Deemed Execution Date, if any |
4. Trans. 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 |
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 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 |
Restricted Stock Unit |
(1) |
11/20/2021 |
|
M |
|
|
2384.3938 |
(2) |
11/20/2021 (2) |
Common Stock |
2384.3938 |
$0.0 |
0 |
D |
|
Restricted Stock Unit |
(1) |
11/20/2021 |
|
M |
|
|
1933.3494 |
(3) |
11/20/2022 (3) |
Common Stock |
1933.3494 |
$0.0 |
3867.7483 |
D |
|
Explanation of
Responses: |
(1) |
Each Restricted Stock Unit
is the economic equivalent of one share of Qualcomm common stock
and is converted into common stock upon vesting. |
(2) |
The Restricted Stock Units
(and allocable dividend equivalents) vest one-third on November 20,
2019, and the remaining balance vest semi-annually
thereafter. |
(3) |
The Restricted Stock Units
(and allocable dividend equivalents) vest one-third on November 20,
2020, and the remaining balance vest semi-annually
thereafter. |
Reporting
Owners
|
Reporting Owner Name / Address |
Relationships
|
Director |
10% Owner |
Officer |
Other |
Palkhiwala Akash J.
5775 MOREHOUSE DR.
SAN DIEGO, CA 92121-1714 |
|
|
Chief Financial Officer |
|
Signatures
|
By: Michele Shea, Attorney-in-Fact For: Akash J
Palkhiwala |
|
11/23/2021 |
**Signature of
Reporting Person |
Date |
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