0001730168-21-000150.txt : 20211216 0001730168-21-000150.hdr.sgml : 20211216 20211216171306 ACCESSION NUMBER: 0001730168-21-000150 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20211214 FILED AS OF DATE: 20211216 DATE AS OF CHANGE: 20211216 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: FERNANDEZ RAUL J CENTRAL INDEX KEY: 0001106627 STATE OF INCORPORATION: CA FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38449 FILM NUMBER: 211498498 MAIL ADDRESS: STREET 1: 11600 SUNRISE VALLEY DR CITY: RESTON STATE: VA ZIP: 20191 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_163969276263361.xml FORM 4 X0306 4 2021-12-14 0 0001730168 Broadcom Inc. AVGO 0001106627 FERNANDEZ RAUL J C/O BROADCOM INC. 1320 RIDDER PARK DRIVE SAN JOSE CA 95131 1 0 0 0 Common Stock, $0.001 par value 2021-12-14 4 P 0 81 612.61 A 2302 D Common Stock, $0.001 par value 2021-12-15 4 P 0 81 615 A 2383 D Includes 476 restricted stock units. /s/ Noelle Matteson, Attorney-in-Fact for Raul J. Fernandez 2021-12-16