0001730168-22-000023.txt : 20220304
0001730168-22-000023.hdr.sgml : 20220304
20220304170536
ACCESSION NUMBER: 0001730168-22-000023
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20220302
FILED AS OF DATE: 20220304
DATE AS OF CHANGE: 20220304
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: SAMUELI HENRY
CENTRAL INDEX KEY: 0001201633
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-38449
FILM NUMBER: 22715105
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]
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_164643151310466.xml
FORM 4
X0306
4
2022-03-02
0
0001730168
Broadcom Inc.
AVGO
0001201633
SAMUELI HENRY
C/O BROADCOM INC.
1320 RIDDER PARK DRIVE
SAN JOSE
CA
95131
1
0
0
0
Common Stock, $0.001 par value
2022-03-02
4
A
0
2500
0
A
269207
D
Common Stock, $0.001 par value
4189608
I
See Footnote
Common Stock, $0.001 par value
1227203
I
See Footnote
Common Stock, $0.001 par value
2893512
I
See Footnote
Common Stock, $0.001 par value
459690
I
See Footnote
On March 2, 2022, the Compensation Committee of the Issuer determined the achievement of certain performance criteria, based on the Issuer's compound annual total stockholder return relative to the S&P 500 Index, and the number of restricted stock units ("RSUs") that will vest with respect to the fourth and final performance period pursuant to the terms of a performance stock unit award granted on March 15, 2018, under the Broadcom Corporation 2012 Stock Incentive Plan. The RSUs are subject to time-based vesting conditions and will vest in full on March 15, 2022, subject to the Reporting Person's continued service through such date. Upon vesting thereof, the Reporting Person is entitled to one (1) share of common stock for each one (1) RSU.
Includes 3,000 RSUs.
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 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 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 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/ Noelle Matteson, Attorney-in-Fact for Henry S. Samueli
2022-03-04