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Samueli Henry – ‘4’ for 9/18/20 re: Broadcom Inc.

On:  Monday, 9/21/20, at 4:33pm ET   ·   For:  9/18/20   ·   Accession #:  1104659-20-107002   ·   File #:  1-38449

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  As Of               Filer                 Filing    For·On·As Docs:Size             Issuer                      Filing Agent

 9/21/20  Samueli Henry                     4                      1:10K  Broadcom Inc.                     Toppan Merrill/FA

Statement of Changes in Beneficial Ownership of Securities by an Insider   —   Form 4   —   SEA’34
Filing Table of Contents

Document/Exhibit                   Description                      Pages   Size 

 1: 4           Statement of Changes in Beneficial Ownership of     HTML      3K 
                Securities by an Insider --                                      
                tm2031404d1_form4.xml/3.6


        

This ‘4’ Document is an XML Data File that may be rendered in various formats:

  Form 4    –   Plain Text   –  SEC Website  –  EDGAR System  –    XML Data    –  <?xml?> File
 
 
Plain Text rendering:  Statement of Changes in Beneficial Ownership of Securities by an Insider
 
                                                                                                                                                                                
Ownership Document
 
Schema Version:  X0306
Document Type:  4
Period of Report:  9/18/20
Not Subject to Section 16:  0
Issuer:
Issuer CIK:  1730168
Issuer Name:  Broadcom Inc.
Issuer Trading Symbol:  AVGO
Reporting Owner:
Reporting Owner ID:
Owner CIK:  1201633
Owner Name:  SAMUELI HENRY
Reporting Owner Address:
Owner Street 1:  C/O BROADCOM INC.
Owner Street 2:  1320 RIDDER PARK DRIVE
Owner City:  SAN JOSE
Owner State:  CA
Owner ZIP Code:  95131
Owner State Description:
Reporting Owner Relationship:
Is Director?  Yes
Is Officer?  No
Is Ten Percent Owner?  No
Is Other?  No
Officer Title:
Other Text:
Non-Derivative Table:
Non-Derivative Holding:
Security Title:
Value:  Common Stock, $0.001 par value
Post-Transaction Amounts:
Shares Owned Following Transaction:
Value:  262,582
Footnote ID:  F1
Ownership Nature:
Direct or Indirect Ownership:
Value:  D
Non-Derivative Transaction:
Security Title:
Value:  Common Stock, par value $0.001k
Transaction Date:
Value:  9/18/20
Deemed Execution Date:
Transaction Coding:
Transaction Form Type:  5
Transaction Code:  G
Equity Swap Involved?  No
Transaction Timeliness:
Value:  E
Transaction Amounts:
Transaction Shares:
Value:  38,850
Transaction Price Per Share:
Value:  0
Transaction Acquired-Disposed Code:
Value:  A
Post-Transaction Amounts:
Shares Owned Following Transaction:
Value:  4,628,084
Footnote ID:  F4
Ownership Nature:
Direct or Indirect Ownership:
Value:  I
Nature of Ownership:
Value:  See Footnote
Footnote ID:  F2
Non-Derivative Transaction:
Security Title:
Value:  Common Stock. $0.001 par value
Transaction Date:
Value:  9/18/20
Deemed Execution Date:
Transaction Coding:
Transaction Form Type:  5
Transaction Code:  G
Equity Swap Involved?  No
Transaction Timeliness:
Value:  E
Transaction Amounts:
Transaction Shares:
Value:  131,062
Transaction Price Per Share:
Value:  0
Transaction Acquired-Disposed Code:
Value:  A
Post-Transaction Amounts:
Shares Owned Following Transaction:
Value:  1,227,203
Footnote ID:  F4
Ownership Nature:
Direct or Indirect Ownership:
Value:  I
Nature of Ownership:
Value:  See Footnote
Footnote ID:  F3
Non-Derivative Holding:
Security Title:
Value:  Common Stock, $0.001 par value
Post-Transaction Amounts:
Shares Owned Following Transaction:
Value:  0
Footnote ID:  F4
Ownership Nature:
Direct or Indirect Ownership:
Value:  I
Nature of Ownership:
Value:  See Footnote
Footnote ID:  F5
Non-Derivative Holding:
Security Title:
Value:  Common Stock, $0.001 par value
Post-Transaction Amounts:
Shares Owned Following Transaction:
Value:  0
Footnote ID:  F4
Ownership Nature:
Direct or Indirect Ownership:
Value:  I
Nature of Ownership:
Value:  See Footnote
Footnote ID:  F6
Non-Derivative Transaction:
Security Title:
Value:  Common Stock, $0.001 par value
Transaction Date:
Value:  9/18/20
Deemed Execution Date:
Transaction Coding:
Transaction Form Type:  4
Transaction Code:  P
Equity Swap Involved?  No
Transaction Timeliness:
Transaction Amounts:
Transaction Shares:
Value:  101,740
Transaction Price Per Share:
Value:  361.45
Transaction Acquired-Disposed Code:
Value:  A
Post-Transaction Amounts:
Shares Owned Following Transaction:
Value:  2,832,299
Ownership Nature:
Direct or Indirect Ownership:
Value:  I
Nature of Ownership:
Value:  See Footnote
Footnote ID:  F7
Non-Derivative Holding:
Security Title:
Value:  Common Stock, $0.001 par value
Post-Transaction Amounts:
Shares Owned Following Transaction:
Value:  459,690
Ownership Nature:
Direct or Indirect Ownership:
Value:  I
Nature of Ownership:
Value:  See Footnote
Footnote ID:  F8
Non-Derivative Holding:
Security Title:
Value:  Common Stock, $0.001 par value
Post-Transaction Amounts:
Shares Owned Following Transaction:
Value:  61,213
Footnote ID:  F4
Ownership Nature:
Direct or Indirect Ownership:
Value:  I
Nature of Ownership:
Value:  See Footnote
Footnote ID:  F9
Footnotes:
Footnote - F1:  Includes 2,641 restricted stock units.
Footnote - F2:  Directly held by D95GT LLC. The Reporting Person disclaims beneficial ownership of these securities except to the extent of his pecuniary interest therein.
Footnote - F3:  Directly held by E95GT LLC. The Reporting Person disclaims beneficial ownership of these securities except to the extent of his pecuniary interest therein.
Footnote - F4:  Reflects change in form of beneficial ownership for no consideration in transaction exempt from Section 16 pursuant to Rule 16a-13 under the Securities Exchange Act of 1934.
Footnote - F5:  Directly held by HS Portfolio L.P. The Reporting Person disclaims beneficial ownership of these securities except to the extent of his pecuniary interest therein.
Footnote - F6:  Directly held by HS Management, L.P. The Reporting Person disclaims beneficial ownership of these securities except to the extent of his pecuniary interest therein.
Footnote - F7:  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.
Footnote - F8:  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.
Footnote - F9:  Directly held by H & S Ventures LLC. The Reporting Person disclaims beneficial ownership of these securities except to the extent of his pecuniary interest therein.
Owner Signature:
Signature Name:  /s/ Henry S. Samueli by Anne G. Plimpton, Attorney in Fact
Signature Date:  9/21/20


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