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