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