0001104659-23-103979.txt : 20230926 0001104659-23-103979.hdr.sgml : 20230926 20230926184606 ACCESSION NUMBER: 0001104659-23-103979 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20230922 FILED AS OF DATE: 20230926 DATE AS OF CHANGE: 20230926 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: SAMUELI HENRY CENTRAL INDEX KEY: 0001201633 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38449 FILM NUMBER: 231281509 MAIL ADDRESS: STREET 1: 5300 CALIFORNIA AVENUE CITY: IRVINE STATE: CA ZIP: 92617-3038 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Broadcom Inc. CENTRAL INDEX KEY: 0001730168 STANDARD INDUSTRIAL CLASSIFICATION: SEMICONDUCTORS & RELATED DEVICES [3674] IRS NUMBER: 352617337 FISCAL YEAR END: 1029 BUSINESS ADDRESS: STREET 1: 1320 RIDDER PARK DRIVE CITY: SAN JOSE STATE: CA ZIP: 95131 BUSINESS PHONE: 408-433-8000 MAIL ADDRESS: STREET 1: 1320 RIDDER PARK DRIVE CITY: SAN JOSE STATE: CA ZIP: 95131 FORMER COMPANY: FORMER CONFORMED NAME: Broadcom Ltd DATE OF NAME CHANGE: 20180201 4 1 tm2326965-1_4seq1.xml OWNERSHIP DOCUMENT X0508 4 2023-09-22 0 0001730168 Broadcom Inc. AVGO 0001201633 SAMUELI HENRY C/O BROADCOM INC. 1320 RIDDER PARK DRIVE SAN JOSE CA 95131 1 0 0 0 0 Common Stock, $0.001 par value 2023-09-22 4 G 0 14125 0 D 4066797 I See Footnote Common Stock, $0.001 par value 2023-09-26 4 G 0 12476 0 D 4054321 I See Footnote Common Stock, $0.001 par value 3162719 I See Footnote Common Stock, $0.001 par value 1227203 I See Footnote Common Stock, $0.001 par value 459690 I See Footnote Directly held by D95GT LLC. The Reporting Person disclaims beneficial ownership of these securities except to the extent of his pecuniary interest therein. Directly held by H&S Investments I L.P. The Reporting Person disclaims beneficial ownership of these securities except to the extent of his pecuniary interest therein. Directly held by E95GT LLC. The Reporting Person disclaims beneficial ownership of these securities except to the extent of his pecuniary interest therein. 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. /s/ Michael J. Sorrow, Attorney-in-fact for Henry S. Samueli 2023-09-26