SEC Form 5
FORM 5 |
UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 ANNUAL STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 or Section 30(h) of the Investment Company Act of 1940 |
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Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b). | |||||||||||||||||
Form 3 Holdings Reported. | |||||||||||||||||
Form 4 Transactions Reported. |
1. Name and Address of Reporting Person*
(Street)
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2. Issuer Name and Ticker or Trading Symbol
LEVI STRAUSS & CO [ LEVI ] |
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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3. Statement for Issuer's Fiscal Year Ended
(Month/Day/Year) 11/27/2022 | ||||||||||||||||||||||||||
4. If Amendment, Date of Original Filed
(Month/Day/Year) |
6. Individual or Joint/Group Filing (Check Applicable Line)
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Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned | |||||||||||||||
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1. Title of Security (Instr. 3) | 2. Transaction Date (Month/Day/Year) | 2A. Deemed Execution Date, if any (Month/Day/Year) | 3. Transaction Code (Instr. 8) | 4. Securities Acquired (A) or Disposed Of (D) (Instr. 3, 4 and 5) | 5. Amount of Securities Beneficially Owned at end of Issuer's Fiscal Year (Instr. 3 and 4) | 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) | 7. Nature of Indirect Beneficial Ownership (Instr. 4) | ||||||||
Amount | (A) or (D) | Price |
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | ||||||||||||||
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1. Title of Derivative Security (Instr. 3) | 2. Conversion or Exercise Price of Derivative Security | 3. Transaction Date (Month/Day/Year) | 3A. Deemed Execution Date, if any (Month/Day/Year) | 4. Transaction Code (Instr. 8) | 5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) | 6. Date Exercisable and Expiration Date (Month/Day/Year) | 7. Title and Amount of Securities Underlying Derivative Security (Instr. 3 and 4) | 8. Price of Derivative Security (Instr. 5) | 9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) | 10. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) | 11. Nature of Indirect Beneficial Ownership (Instr. 4) | |||
(A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | |||||||||
Class B Common Stock | $0 | 12/06/2021 | J(5) | 124,375 | (1) | (1) | Class A Common Stock | (1) | $0 | 1,322,379 | I | By spouse | ||
Class B Common Stock | $0 | 12/14/2021 | G | 1,268 | (1) | (1) | Class A Common Stock | (1) | $0 | 41,957 | D | |||
Class B Common Stock | $0 | 12/14/2021 | G | 1,268 | (1) | (1) | Class A Common Stock | (1) | $0 | 1,322,379 | I | By spouse | ||
Class B Common Stock | $0 | 12/14/2021 | G(3) | 3,804 | (1) | (1) | Class A Common Stock | (1) | $0 | 1,322,379 | I | By spouse | ||
Class B Common Stock | $0 | 12/14/2021 | G(3) | 3,804 | (1) | (1) | Class A Common Stock | (1) | $0 | 188,862 | I | By spouse as custodian | ||
Class B Common Stock | $0 | 12/14/2021 | G(4) | 3,804 | (1) | (1) | Class A Common Stock | (1) | $0 | 188,862 | I | By spouse as custodian | ||
Class B Common Stock | $0 | 02/10/2022 | G | 1,349 | (1) | (1) | Class A Common Stock | (1) | $0 | 41,957 | D | |||
Class B Common Stock | $0 | 02/10/2022 | G | 1,349 | (1) | (1) | Class A Common Stock | (1) | $0 | 3,337,143 | I | As trustee(2) | ||
Class B Common Stock | $0 | 02/10/2022 | G | 1,349 | (1) | (1) | Class A Common Stock | (1) | $0 | 1,322,379 | I | By spouse | ||
Class B Common Stock | $0 | 02/10/2022 | G(3) | 4,047 | (1) | (1) | Class A Common Stock | (1) | $0 | 1,322,379 | I | By spouse | ||
Class B Common Stock | $0 | 02/10/2022 | G(3) | 4,047 | (1) | (1) | Class A Common Stock | (1) | $0 | 188,862 | I | By spouse as custodian | ||
Class B Common Stock | $0 | 02/10/2022 | G(4) | 4,407 | (1) | (1) | Class A Common Stock | (1) | $0 | 188,862 | I | By spouse as custodian | ||
Class B Common Stock | $0 | 06/06/2022 | J(5) | 153,988 | (1) | (1) | Class A Common Stock | (1) | $0 | 1,322,379 | I | By spouse |
Explanation of Responses: |
1. Each share of Class B Common Stock is convertible into one share of Class A Common Stock at the option of the holder and has no expiration date. |
2. Represents (i) 3,327,143 shares of Class B Common Stock held by grantor retained annuity trusts, for which the reporting person serves as trustee and (ii) 10,000 shares of Class B Common Stock held by Haas Prime Family 2012 Trust, for which the reporting person and his spouse serve as co-trustees. Mr. Haas disclaims beneficial ownership of these shares except to the extent of his pecuniary interest therein. |
3. Gift of shares of from the reporting person's spouse to custodial accounts for the benefit of the children of the reporting person, for which the spouse of the reporting person serves as custodian. Mr. Haas disclaims beneficial ownership of these shares. |
4. Gift of shares to custodial accounts for the benefit of the children of the reporting person, for which the spouse of the reporting person serves as custodian. Mr. Haas disclaims beneficial ownership of these shares. |
5. On the Transaction Date, one or more grantor retained annuity trusts for the benefit of the spouse of the reporting person and the remainder beneficiaries distributed shares of Class B Common Stock to the spouse of the reporting person. Mr. Haas disclaims beneficial ownership of these shares. |
/s/ Parker B. Phillips,, attorney-in-fact | 01/09/2023 | |
** Signature of Reporting Person | Date | |
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | ||
* If the form is filed by more than one reporting person, see Instruction 4 (b)(v). | ||
** Intentional misstatements or omissions of facts constitute Federal Criminal Violations See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). | ||
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure. | ||
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number. |