0001730168-21-000087.txt : 20210407
0001730168-21-000087.hdr.sgml : 20210407
20210407174239
ACCESSION NUMBER: 0001730168-21-000087
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20210405
FILED AS OF DATE: 20210407
DATE AS OF CHANGE: 20210407
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Kawwas Charlie B
CENTRAL INDEX KEY: 0001608425
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-38449
FILM NUMBER: 21813189
MAIL ADDRESS:
STREET 1: C/O AVAGO TECHNOLOGIES U.S. INC.
STREET 2: 350 WEST TRIMBLE ROAD
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_161783171781596.xml
FORM 4
X0306
4
2021-04-05
0
0001730168
Broadcom Inc.
AVGO
0001608425
Kawwas Charlie B
C/O BROADCOM INC.
1320 RIDDER PARK DRIVE
SAN JOSE
CA
95131
0
1
0
0
Chief Operating Officer
Common Stock, $0.001 par value
2021-04-05
4
A
0
17940
0
A
82600
D
Award approved on December 8, 2020, subject to stockholder approval of the Broadcom Inc. 2012 Stock Incentive Plan (amended and restated on April 5, 2021) (the "2012 Plan"), with an effective grant date of April 5, 2021.
Award of Restricted Stock Units ("RSUs") granted pursuant to the 2012 Plan. Upon vesting thereof, the Reporting Person is entitled to one (1) share of common stock for each one (1) RSU. The RSUs vest over a three-year period, with one-third of the RSUs vesting on each anniversary of December 15, 2020, subject to continued service with the Issuer.
Includes 53,565 RSUs.
/s/ Noelle Matteson, Attorney-In-Fact for Charlie B Kawwas
2021-04-07