0000899243-22-001767.txt : 20220112 0000899243-22-001767.hdr.sgml : 20220112 20220112171558 ACCESSION NUMBER: 0000899243-22-001767 CONFORMED SUBMISSION TYPE: 5 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20211128 FILED AS OF DATE: 20220112 DATE AS OF CHANGE: 20220112 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Haas Miriam L CENTRAL INDEX KEY: 0001768680 FILING VALUES: FORM TYPE: 5 SEC ACT: 1934 Act SEC FILE NUMBER: 001-06631 FILM NUMBER: 22527218 MAIL ADDRESS: STREET 1: C/O LEVI STRAUSS & CO. STREET 2: 1155 BATTERY STREET CITY: SAN FRANCISCO STATE: CA ZIP: 94111 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: LEVI STRAUSS & CO CENTRAL INDEX KEY: 0000094845 STANDARD INDUSTRIAL CLASSIFICATION: APPAREL & OTHER FINISHED PRODS OF FABRICS & SIMILAR MATERIAL [2300] IRS NUMBER: 940905160 STATE OF INCORPORATION: DE FISCAL YEAR END: 1128 BUSINESS ADDRESS: STREET 1: 1155 BATTERY ST CITY: SAN FRANCISCO STATE: CA ZIP: 94111 BUSINESS PHONE: 4155016000 MAIL ADDRESS: STREET 1: 1155 BATTERY STREET CITY: SAN FRANCISCO STATE: CA ZIP: 94111 5 1 doc5.xml FORM 5 SUBMISSION X0306 5 2021-11-28 0 0 0 0000094845 LEVI STRAUSS & CO LEVI 0001768680 Haas Miriam L C/O ARGONAUT SECURITIES COMPANY 1155 BATTERY STREET SAN FRANCISCO CA 94111 0 0 1 0 Class B Common Stock 2021-04-08 5 J 0 914825 0.00 D Class A Common Stock 5085175 I By grantor retained annuity trust Class B Common Stock 2021-04-08 5 J 0 914825 0.00 A Class A Common Stock 38774087 D Class B Common Stock 2021-10-08 5 J 0 852205 0.00 D Class A Common Stock 4232970 I By grantor retained annuity trust Class B Common Stock 2021-10-08 5 J 0 852205 0.00 A Class A Common Stock 39526292 D 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. Shares reflect distributions from a grantor retained annuity trust for the benefit of the reporting person and the remainder beneficiaries. /s/ Parker Phillips, Attorney-in-Fact 2022-01-12