0000904454-21-000733.txt : 20211029 0000904454-21-000733.hdr.sgml : 20211029 20211029201652 ACCESSION NUMBER: 0000904454-21-000733 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20211027 FILED AS OF DATE: 20211029 DATE AS OF CHANGE: 20211029 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: CARLSON DOUGLAS J CENTRAL INDEX KEY: 0001719731 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-35451 FILM NUMBER: 211364939 MAIL ADDRESS: STREET 1: MACOM TECHNOLOGY SOLUTIONS HOLDINGS INC. STREET 2: 100 CHELMSFORD ST. CITY: LOWELL STATE: MA ZIP: 01851 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: MACOM Technology Solutions Holdings, Inc. CENTRAL INDEX KEY: 0001493594 STANDARD INDUSTRIAL CLASSIFICATION: SEMICONDUCTORS & RELATED DEVICES [3674] IRS NUMBER: 270306875 STATE OF INCORPORATION: DE FISCAL YEAR END: 1001 BUSINESS ADDRESS: STREET 1: 100 CHELMSFORD STREET CITY: LOWELL STATE: MA ZIP: 01851 BUSINESS PHONE: (978) 656-2500 MAIL ADDRESS: STREET 1: 100 CHELMSFORD STREET CITY: LOWELL STATE: MA ZIP: 01851 FORMER COMPANY: FORMER CONFORMED NAME: M/A-COM Technology Solutions Holdings, Inc. DATE OF NAME CHANGE: 20100607 4 1 edgar.xml PRIMARY DOCUMENT X0306 4 2021-10-27 0001493594 MACOM Technology Solutions Holdings, Inc. MTSI 0001719731 CARLSON DOUGLAS J C/O MACOM TECHNOLOGY SOLUTIONS HOLDINGS 100 CHELMSFORD STREET LOWELL MA 01851 0 1 0 0 SVP, Technology Common Stock 2021-10-27 4 A 0 3044 0 A 55653 D Common Stock 2021-10-28 4 F 0 581 69.63 D 55072 D Common Stock 2021-10-29 4 F 0 4103 69.82 D 50969 D Represents restricted stock units granted to the Reporting Person under the Issuer's 2021 Omnibus Incentive Plan. Each restricted stock unit represents the contingent right to receive one share of Common Stock. The restricted stock units vest in three equal annual installments on October 27, 2022, October 27, 2023 and October 27, 2024, provided that the Reporting Person remains in continuous service with the Issuer through each such vesting date. Shares withheld by the Issuer to satisfy the Reporting Person's tax withholding obligations in connection with the vesting of restricted stock units on October 28, 2021. Shares withheld by the Issuer to satisfy the Reporting Person's tax withholding obligations in connection with the vesting of restricted stock units on October 29, 2021. /s/ Ambra R. Roth, Attorney-in-Fact 2021-10-29