0001730168-21-000118.txt : 20210621
0001730168-21-000118.hdr.sgml : 20210621
20210621171149
ACCESSION NUMBER: 0001730168-21-000118
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20210617
FILED AS OF DATE: 20210621
DATE AS OF CHANGE: 20210621
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: TAN HOCK E
CENTRAL INDEX KEY: 0001211588
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-38449
FILM NUMBER: 211031797
MAIL ADDRESS:
STREET 1: BROADCOM INC.
STREET 2: 1320 RIDDER PARK DRIVE
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_162430986932124.xml
FORM 4
X0306
4
2021-06-17
0
0001730168
Broadcom Inc.
AVGO
0001211588
TAN HOCK E
C/O BROADCOM INC.
1320 RIDDER PARK DRIVE
SAN JOSE
CA
95131
1
1
0
0
President and CEO
Common Stock, $0.001 par value
2021-06-17
4
A
0
363996
0
A
581828
D
Common Stock, $0.001 par value
2021-06-17
4
F
0
180151
471.17
D
401677
D
On June 17, 2021, the independent members of the Issuer's Board of Directors determined the achievement of certain performance criteria, based on the Issuer's total stockholder return ("TSR") performance as compared to the S&P 500 Index and the Issuer's absolute TSR, over a four year performance period ending on June 14, 2021, and the number of shares of common stock earned and issuable pursuant to the terms of a performance stock unit award granted on June 15, 2017 (the "2017 Award") under the Avago Technologies Limited 2009 Equity Incentive Award Plan.
Consists of shares withheld by the Issuer to satisfy the tax withholding obligations of the Reporting Person upon the vesting of the 2017 Award.
/s/ Noelle Matteson, Attorney-in-Fact for Hock E. Tan
2021-06-21