SEC FORM 5

SEC FORM 5 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^*

Haas Robert D.

(Last)

(First)

(Middle)

C/O ARGONAUT SECURITIES COMPANY

1155 BATTERY STREET

(Street)

SAN FRANCISCO

94111

(City)

(State)

(Zip)

2. Issuer Name and Ticker or Trading Symbol
LEVI STRAUSS & CO [ LEVI ]

5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)

Director	X	10% Owner
Officer (give title below)		Other (specify below)

3. Statement for Issuer's Fiscal Year Ended (Month/Day/Year)
11/28/2021

4. If Amendment, Date of Original Filed (Month/Day/Year)

6. Individual or Joint/Group Filing (Check Applicable Line)

X	Form filed by One Reporting Person
	Form filed by More than One Reporting Person

Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
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)
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)	Amount	(A) or (D)	Price		6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)	7. Nature of Indirect Beneficial Ownership (Instr. 4)

Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
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)
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)	(A)	(D)	Date Exercisable	Expiration Date	Title	Amount or Number of Shares	8. Price of Derivative Security (Instr. 5)		10. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)	11. Nature of Indirect Beneficial Ownership (Instr. 4)
Class B Common Stock	$0	12/02/2020		J⁽¹⁾		828,068	⁽⁷⁾	⁽⁷⁾	Class A Common Stock	⁽⁷⁾	$0	3,070,817	I	By grantor retained annuity trusts
Class B Common Stock	$0	12/02/2020		J⁽¹⁾	828,068		⁽⁷⁾	⁽⁷⁾	Class A Common Stock	⁽⁷⁾	$0	250,000	D
Class B Common Stock	$0	12/02/2020		J⁽⁴⁾		828,068	⁽⁷⁾	⁽⁷⁾	Class A Common Stock	⁽⁷⁾	$0	250,000	D
Class B Common Stock	$0	12/02/2020		J⁽⁴⁾	828,068		⁽⁷⁾	⁽⁷⁾	Class A Common Stock	⁽⁷⁾	$0	3,070,817	I	By grantor retained annuity trusts
Class B Common Stock	$0	12/02/2020		J⁽²⁾		592,182	⁽⁷⁾	⁽⁷⁾	Class A Common Stock	⁽⁷⁾	$0	4,252,141	I	By grantor retained annuity trusts of spouse
Class B Common Stock	$0	12/02/2020		J⁽²⁾	592,182		⁽⁷⁾	⁽⁷⁾	Class A Common Stock	⁽⁷⁾	$0	0	I	By spouse⁽⁶⁾
Class B Common Stock	$0	12/02/2020		J⁽⁵⁾		592,182	⁽⁷⁾	⁽⁷⁾	Class A Common Stock	⁽⁷⁾	$0	0	I	By spouse⁽⁶⁾
Class B Common Stock	$0	12/02/2020		J⁽⁵⁾	592,182		⁽⁷⁾	⁽⁷⁾	Class A Common Stock	⁽⁷⁾	$0	4,252,141	I	By grantor retained annuity trusts of spouse
Class B Common Stock	$0	03/29/2021		J⁽¹⁾		618,862	⁽⁷⁾	⁽⁷⁾	Class A Common Stock	⁽⁷⁾	$0	3,070,817	I	By grantor retained annuity trusts
Class B Common Stock	$0	03/29/2021		J⁽¹⁾	618,862		⁽⁷⁾	⁽⁷⁾	Class A Common Stock	⁽⁷⁾	$0	250,000	D
Class B Common Stock	$0	03/29/2021		J⁽⁴⁾		193,862	⁽⁷⁾	⁽⁷⁾	Class A Common Stock	⁽⁷⁾	$0	250,000	D
Class B Common Stock	$0	03/29/2021		J⁽⁴⁾	193,862		⁽⁷⁾	⁽⁷⁾	Class A Common Stock	⁽⁷⁾	$0	3,070,817	I	By grantor retained annuity trusts
Class B Common Stock	$0	03/29/2021		J⁽²⁾		624,277	⁽⁷⁾	⁽⁷⁾	Class A Common Stock	⁽⁷⁾	$0	4,252,141	I	By grantor retained annuity trusts of spouse
Class B Common Stock	$0	03/29/2021		J⁽²⁾	624,277		⁽⁷⁾	⁽⁷⁾	Class A Common Stock	⁽⁷⁾	$0	0	I	To spouse⁽⁶⁾
Class B Common Stock	$0	03/29/2021		J⁽⁵⁾		624,277	⁽⁷⁾	⁽⁷⁾	Class A Common Stock	⁽⁷⁾	$0	0	I	By spouse⁽⁶⁾
Class B Common Stock	$0	03/29/2021		J⁽⁵⁾	624,277		⁽⁷⁾	⁽⁷⁾	Class A Common Stock	⁽⁷⁾	$0	4,252,141	I	By grantor retained annuity trusts of spouse
Class B Common Stock	$0	06/02/2021		J⁽¹⁾		426,661	⁽⁷⁾	⁽⁷⁾	Class A Common Stock	⁽⁷⁾	$0	3,070,817	I	By grantor retained annuity trusts
Class B Common Stock	$0	06/02/2021		J⁽¹⁾	426,661		⁽⁷⁾	⁽⁷⁾	Class A Common Stock	⁽⁷⁾	$0	250,000	D
Class B Common Stock	$0	06/02/2021		J⁽³⁾		28,720	⁽⁷⁾	⁽⁷⁾	Class A Common Stock	⁽⁷⁾	$0	250,000	D
Class B Common Stock	$0	06/02/2021		J⁽³⁾	28,720		⁽⁷⁾	⁽⁷⁾	Class A Common Stock	⁽⁷⁾	$0	0	I	By spouse⁽⁶⁾
Class B Common Stock	$0	06/02/2021		J⁽²⁾		305,123	⁽⁷⁾	⁽⁷⁾	Class A Common Stock	⁽⁷⁾	$0	4,252,141	I	By grantor retained annuity trusts of spouse
Class B Common Stock	$0	06/02/2021		J⁽²⁾	305,123		⁽⁷⁾	⁽⁷⁾	Class A Common Stock	⁽⁷⁾	$0	0	I	By spouse⁽⁶⁾
Class B Common Stock	$0	06/02/2021		J⁽³⁾		123,880	⁽⁷⁾	⁽⁷⁾	Class A Common Stock	⁽⁷⁾	$0	250,000	D
Class B Common Stock	$0	06/02/2021		J⁽³⁾	123,880		⁽⁷⁾	⁽⁷⁾	Class A Common Stock	⁽⁷⁾	$0	0	I	By spouse⁽⁶⁾
Class B Common Stock	$0	09/30/2021		J⁽¹⁾		464,594	⁽⁷⁾	⁽⁷⁾	Class A Common Stock	⁽⁷⁾	$0	3,070,817	I	By grantor retained annuity trusts
Class B Common Stock	$0	09/30/2021		J⁽¹⁾	464,594		⁽⁷⁾	⁽⁷⁾	Class A Common Stock	⁽⁷⁾	$0	250,000	D
Class B Common Stock	$0	09/30/2021		J⁽⁴⁾		488,655	⁽⁷⁾	⁽⁷⁾	Class A Common Stock	⁽⁷⁾	$0	250,000	D
Class B Common Stock	$0	09/30/2021		J⁽⁴⁾	488,665		⁽⁷⁾	⁽⁷⁾	Class A Common Stock	⁽⁷⁾	$0	3,070,817	I	By grantor retained annuity trusts
Class B Common Stock	$0	09/29/2021		J⁽²⁾		630,057	⁽⁷⁾	⁽⁷⁾	Class A Common Stock	⁽⁷⁾	$0	4,252,141	I	By grantor retained annuity trusts of spouse
Class B Common Stock	$0	09/29/2021		J⁽²⁾	630,057		⁽⁷⁾	⁽⁷⁾	Class A Common Stock	⁽⁷⁾	$0	0	I	By spouse⁽⁶⁾

Explanation of Responses:

1. On the Transaction Date, one or more grantor retained annuity trusts for the benefit of the reporting person and the remainder beneficiaries distributed shares of Class B Common Stock to the reporting person.

2. 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.

3. On the Transaction Date, the reporting person distributed shares of Class B Common Stock to his spouse. Mr. Haas disclaims beneficial ownership of these shares.

4. On the Transaction Date, the reporting person distributed shares of Class B Common Stock to one or more grantor retained annuity trusts for the benefit of himself and the remainder beneficiaries.

5. On the Transaction Date, the reporting person's spouse distributed shares of Class B Common Stock to one or more grantor retained annuity trusts for the benefit of herself and the remainder beneficiaries. Mr. Haas disclaims beneficial ownership of these shares.

6. Mr. Haas disclaims beneficial ownership of these shares.

7. 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.

	/s/ Parker Phillips, attorney-in-fact	01/10/2022
	** 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).
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