0001730168-24-000067.txt : 20240424
0001730168-24-000067.hdr.sgml : 20240424
20240424184732
ACCESSION NUMBER: 0001730168-24-000067
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20240422
FILED AS OF DATE: 20240424
DATE AS OF CHANGE: 20240424
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: SAMUELI HENRY
CENTRAL INDEX KEY: 0001201633
ORGANIZATION NAME:
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-38449
FILM NUMBER: 24872261
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]
ORGANIZATION NAME: 04 Manufacturing
IRS NUMBER: 352617337
FISCAL YEAR END: 1103
BUSINESS ADDRESS:
STREET 1: 3421 HILLVIEW AVENUE
CITY: PALO ALTO
STATE: CA
ZIP: 94304
BUSINESS PHONE: 650-427-6000
MAIL ADDRESS:
STREET 1: 3421 HILLVIEW AVENUE
CITY: PALO ALTO
STATE: CA
ZIP: 94304
FORMER COMPANY:
FORMER CONFORMED NAME: Broadcom Ltd
DATE OF NAME CHANGE: 20180201
4
1
wk-form4_1713998841.xml
FORM 4
X0508
4
2024-04-22
0
0001730168
Broadcom Inc.
AVGO
0001201633
SAMUELI HENRY
C/O BROADCOM INC.
3421 HILLVIEW AVENUE
PALO ALTO
CA
94304
1
0
0
0
0
Common Stock, $0.001 par value
2024-04-22
4
A
0
189
0
A
189
D
Common Stock, $0.001 par value
3990163
I
See Footnote
Common Stock, $0.001 par value
3157399
I
See Footnote
Common Stock, $0.001 par value
1227203
I
See Footnote
Common Stock, $0.001 par value
459690
I
See Footnote
Grant of Restricted Stock Units ("RSUs"). Upon vesting thereof, the Reporting Person is entitled to receive one (1) share of the Issuer's common stock for each one (1) RSU. The Vesting Commencement Date is April 22, 2024. The RSUs vest in full on the earlier of (i) the first anniversary of the Vesting Commencement Date or (ii) the date on which the annual meeting of the Issuer's stockholders immediately following the Vesting Commencement Date is held, subject to the Reporting Person's continuing service on the vesting date.
Represents 189 RSUs.
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/ Noelle Matteson, Attorney-in-Fact for Henry Samueli
2024-04-24