0001730168-21-000159.txt : 20211217 0001730168-21-000159.hdr.sgml : 20211217 20211217171538 ACCESSION NUMBER: 0001730168-21-000159 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: Krause Thomas H. CENTRAL INDEX KEY: 0001670643 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38449 FILM NUMBER: 211502610 MAIL ADDRESS: STREET 1: 1320 RIDDER PARK 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_163977931455988.xml FORM 4 X0306 4 2021-12-15 0 0001730168 Broadcom Inc. AVGO 0001670643 Krause Thomas H. C/O BROADCOM INC. 1320 RIDDER PARK DRIVE SAN JOSE CA 95131 0 1 0 0 President of Broadcom SW Group Common Stock, $0.001 par value 2021-12-15 4 F 0 3585 639.86 D 50105 D Common Stock, $0.001 par value 2021-12-16 4 S 0 3645 632.84 D 46460 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 46,460 RSUs. Represents 46,460 RSUs. /s/Noelle Matteson, Attorney-in-Fact for Thomas H. Krause, Jr. 2021-12-17