0000904454-21-000269.txt : 20210301 0000904454-21-000269.hdr.sgml : 20210301 20210301164035 ACCESSION NUMBER: 0000904454-21-000269 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20210226 FILED AS OF DATE: 20210301 DATE AS OF CHANGE: 20210301 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: OCAMPO JOHN L CENTRAL INDEX KEY: 0001248224 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-35451 FILM NUMBER: 21698562 MAIL ADDRESS: STREET 1: 100 CHELMSFORD STREET CITY: LOWELL STATE: MA ZIP: 01851 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: OCAMPO SUSAN CENTRAL INDEX KEY: 0001252243 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-35451 FILM NUMBER: 21698561 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 2021-02-26 0001493594 MACOM Technology Solutions Holdings, Inc. MTSI 0001248224 OCAMPO JOHN L C/O MACOM TECHNOLOGY SOLUTIONS HOLDINGS 100 CHELMSFORD STREET LOWELL MA 01851 1 1 1 0 Chairman 0001252243 OCAMPO SUSAN C/O MACOM TECHNOLOGY SOLUTIONS HOLDINGS 100 CHELMSFORD STREET LOWELL MA 01851 1 0 1 0 Common Stock 2021-02-26 5 G 0 1000000 0 D 8533142 I By Ocampo Family Trust-2001 Common Stock 2021-02-26 5 G 0 500000 0 A 500000 I By John Ocampo 2021 Charitable Remainder Trust Common Stock 2021-02-26 5 G 0 500000 0 A 500000 I By Susan Ocampo 2021 Charitable Remainder Trust Common Stock 3047742 I By trust for son Common Stock 3220242 I By trust for daughter Common Stock 3220242 I By trust for son The Reporting Persons are trustees of the Ocampo Family Trust - 2001, the John Ocampo 2021 Charitable Remainder Trust, the Susan Ocampo 2021 Charitable Remainder Trust, and the trusts for the benefit of their children. /s/ Ambra R. Roth, Attorney-in-Fact for John Ocampo and Susan Ocampo 2021-03-01