0001730168-21-000161.txt : 20211217 0001730168-21-000161.hdr.sgml : 20211217 20211217172048 ACCESSION NUMBER: 0001730168-21-000161 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20211215 FILED AS OF DATE: 20211217 DATE AS OF CHANGE: 20211217 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Kawwas Charlie B CENTRAL INDEX KEY: 0001608425 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38449 FILM NUMBER: 211502699 MAIL ADDRESS: STREET 1: C/O AVAGO TECHNOLOGIES U.S. INC. STREET 2: 350 WEST TRIMBLE ROAD CITY: SAN JOSE STATE: CA ZIP: 95131 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Broadcom Inc. CENTRAL INDEX KEY: 0001730168 STANDARD INDUSTRIAL CLASSIFICATION: SEMICONDUCTORS & RELATED DEVICES [3674] IRS NUMBER: 000000000 STATE OF INCORPORATION: DE FISCAL YEAR END: 1031 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_163977962027712.xml FORM 4 X0306 4 2021-12-15 0 0001730168 Broadcom Inc. AVGO 0001608425 Kawwas Charlie B C/O BROADCOM INC. 1320 RIDDER PARK DRIVE SAN JOSE CA 95131 0 1 0 0 Chief Operating Officer Common Stock, $0.001 par value 2021-12-15 4 F 0 3585 639.86 D 75017 D Consists of shares withheld by the Issuer to satisfy the tax withholding obligations of the Reporting Person upon the vesting of the relevant restricted stock units ("RSUs") previously granted to the Reporting Person. Includes 46,335 RSUs and 2 shares acquired under the Issuer's Employee Stock Purchase Plan on September 14, 2021. /s/ Noelle Matteson, Attorney-In-Fact for Charlie B Kawwas 2021-12-17