0001104659-24-048357.txt : 20240417 0001104659-24-048357.hdr.sgml : 20240417 20240417164723 ACCESSION NUMBER: 0001104659-24-048357 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20240415 FILED AS OF DATE: 20240417 DATE AS OF CHANGE: 20240417 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: 24851695 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 tm2412068-1_4seq1.xml OWNERSHIP DOCUMENT X0508 4 2024-04-15 0 0001730168 Broadcom Inc. AVGO 0001201633 SAMUELI HENRY C/O BROADCOM INC. 3421 HILLVIEW AVENUE PALO ALTO CA 94304 1 0 0 0 1 Common Stock, $0.001 par value 2024-04-15 4 G 0 18601 0 D 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 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/ Michael J. Sorrow, Attorney-in-fact for Henry S. Samueli 2024-04-17