FORM 5
[ ] 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
UNITED STATES SECURITIES AND EXCHANGE COMMISSION | OMB APPROVAL |
OMB Number: 3235-0362 | |
Washington, D.C. 20549 | Estimated average burden |
hours per response... 1.0 |
ANNUAL STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP
OF SECURITIES
Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 or
Section 30(h) of the Investment Company Act of 1940
1. Name and Address of Reporting Person * | 2. Issuer Name and Ticker or Trading Symbol | 5. Relationship of Reporting Person(s) to Issuer |
(Check all applicable) |
Haas Miriam L | LEVI STRAUSS & CO [LEVI] | _____ Director | __X__ 10% Owner | |||||||||||||||||||||||
(Last) | (First) | (Middle) | 3. Statement for Issuer's Fiscal Year Ended | |||||||||||||||||||||||
_____ Officer (give title below) | _____ Other (specify below) | |||||||||||||||||||||||||
(MM/DD/YYYY) | 11/24/2019 | |||||||||||||||||||||||||
C/O ARGONAUT SECURITIES | ||||||||||||||||||||||||||
COMPANY, 1155 BATTERY STREET | ||||||||||||||||||||||||||
(Street) | 4. If Amendment, Date Original Filed(MM/DD/YYYY) | 6. Individual or Joint/Group Filing(Check Applicable Line) | ||||||||||||||||||||||||
SAN FRANCISCO, CA 94111 | _X_ Form Filed by One Reporting Person | |||||||||||||||||||||||||
(City) | (State) | (Zip) | ___ Form Filed by More than One Reporting Person | |||||||||||||||||||||||
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned | ||||||||||||||||||||||||||
1.Title of Security | 2. Trans. Date | 2A. Deemed | 3. Trans. Code | 4. Securities Acquired (A) | 5. Amount of Securities Beneficially Owned | 6. | 7. Nature | |||||||||||||||||||
(Instr. 3) | Execution | (Instr. 8) | or Disposed of (D) | Following Reported Transaction(s) | Ownership | of Indirect | ||||||||||||||||||||
Date, if any | (Instr. 3, 4 and 5) | (Instr. 3 and 4) | Form: | Beneficial | ||||||||||||||||||||||
Direct (D) | Ownership | |||||||||||||||||||||||||
or Indirect | (Instr. 4) | |||||||||||||||||||||||||
(A) or | (I) | |||||||||||||||||||||||||
Amount | (D) | Price | (Instr. 4) | |||||||||||||||||||||||
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | ||||||||||||||||||||||||||
1. Title of Derivate | 2. | 3. Trans. | 3A. Deemed | 4. Trans. | 5. Number of Derivative | 6. Date Exercisable and | 7. Title and Amount of | 8. Price of | 9. Number | 10. | 11. Nature | |||||||||||||||
Security | Conversion | Date | Execution | Code | Securities Acquired (A) | Expiration Date | Securities Underlying | Derivative | of | Ownership | of Indirect | |||||||||||||||
(Instr. 3) | or Exercise | Date, if any | (Instr. 8) | or Disposed of (D) | (MM/DD/YYYY) | Derivative Security | Security | Derivative | Form of | Beneficial | ||||||||||||||||
Price of | (Instr. 3, 4 and 5) | (Instr. 3 and 4) | (Instr. 5) | Securities | Derivative | Ownership | ||||||||||||||||||||
Derivative | Beneficially | Security: | (Instr. 4) | |||||||||||||||||||||||
Security | Amount or | Owned at | Direct (D) | |||||||||||||||||||||||
Date | Expiration | End of | or Indirect | |||||||||||||||||||||||
Exercisable | Date | Title | Number of | Issuer's | (I) | |||||||||||||||||||||
Shares | Fiscal Year | (Instr. 4) | ||||||||||||||||||||||||
(A) | (D) | (Instr. 4) | ||||||||||||||||||||||||
Class B Common | Class A | D(2) | ||||||||||||||||||||||||
5/3/2019 | J | 50050 | Common | $0.00 | 18511530 | |||||||||||||||||||||
Stock | ||||||||||||||||||||||||||
Stock | ||||||||||||||||||||||||||
By | ||||||||||||||||||||||||||
Class B Common | Class A | grantor | ||||||||||||||||||||||||
5/3/2019 | J | 38690 | Common | $0.00 | 38397160 | I | retained | |||||||||||||||||||
Stock | ||||||||||||||||||||||||||
Stock | annuity | |||||||||||||||||||||||||
trusts (2) | ||||||||||||||||||||||||||
By | ||||||||||||||||||||||||||
Class B Common | Class A | grantor | ||||||||||||||||||||||||
5/30/2019 | J | 6270726 | Common | $0.00 | 32126434 | I | retained | |||||||||||||||||||
Stock | ||||||||||||||||||||||||||
Stock | annuity | |||||||||||||||||||||||||
trusts (3) | ||||||||||||||||||||||||||
Class B Common | Class A | D(3) | ||||||||||||||||||||||||
5/30/2019 | J | 4009981 | Common | $0.00 | 22521511 | |||||||||||||||||||||
Stock | ||||||||||||||||||||||||||
Stock | ||||||||||||||||||||||||||
By | ||||||||||||||||||||||||||
Class B Common | Class A | grantor | ||||||||||||||||||||||||
9/16/2019 | J | 8054300 | Common | $0.00 | 24072134 | I | retained | |||||||||||||||||||
Stock | ||||||||||||||||||||||||||
Stock | annuity | |||||||||||||||||||||||||
trusts (3) | ||||||||||||||||||||||||||
Class B Common | Class A | D(3) | ||||||||||||||||||||||||
9/16/2019 | J | 7569649 | Common | $0.00 | 30091160 | |||||||||||||||||||||
Stock | ||||||||||||||||||||||||||
Stock | ||||||||||||||||||||||||||
Explanation of Responses:
- 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.
- On May 3, 2019, the reporting person distributed 50,050 shares of Class B Common Stock to several grantor retained annuity trusts for the benefit of herself and the remainder beneficiaries in order to reflect an adjustment in a prior valuation.
- Shares reflect distributions from several grantor retained annuity trusts for the benefit of the reporting person and the remainder beneficiaries.
Reporting Owners
Reporting Owner Name / Address | Relationships |
Director 10% Owner OfficerOther | |
Haas Miriam L
C/O ARGONAUT SECURITIES COMPANYX 1155 BATTERY STREET
SAN FRANCISCO, CA 94111
Signatures | ||
/s/ Parker Phillips, Attorney-in-Fact | 1/7/2020 | |
**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.
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Levi Strauss & Co. published this content on 07 January 2020 and is solely responsible for the information contained therein. Distributed by Public, unedited and unaltered, on 07 January 2020 20:57:05 UTC