0001730168-22-000063.txt : 20220406 0001730168-22-000063.hdr.sgml : 20220406 20220406162435 ACCESSION NUMBER: 0001730168-22-000063 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20220404 FILED AS OF DATE: 20220406 DATE AS OF CHANGE: 20220406 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: DELLY GAYLA J CENTRAL INDEX KEY: 0001218358 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38449 FILM NUMBER: 22810817 MAIL ADDRESS: STREET 1: 3000 TECHNOLOGY DR CITY: ANGLETON STATE: TX ZIP: 77515 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: 1030 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 wf-form4_164927664644897.xml FORM 4 X0306 4 2022-04-04 0 0001730168 Broadcom Inc. AVGO 0001218358 DELLY GAYLA J C/O BROADCOM INC. 1320 RIDDER PARK DRIVE SAN JOSE CA 95131 1 0 0 0 Common Stock, $0.001 par value 2022-04-04 4 A 0 413 0 A 3464 D Grant of Restricted Stock Units ("RSUs"). Upon vesting thereof, the Reporting Person is entitled to receive one (1) share of Issuer's common stock for each one (1) RSU. The Vesting Commencement Date is April 4, 2022. 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 Issuer's stockholders immediately following the Vesting Commencement Date is held, subject to Reporting Person's continuing service on the vesting date. Includes 413 RSUs. /s/ Noelle Matteson, Attorney-in-Fact for Gayla J. Delly 2022-04-06