Annual Statement of Changes in Beneficial Ownership (5)
February 11 2022 - 5:42PM
Edgar (US Regulatory)
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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).
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Form 3 Holdings Reported
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Form 4 Transactions Reported
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
ANNUAL STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
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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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1. Name and Address of Reporting Person
*
STOREY JEFFREY K | 2. Issuer Name and Ticker or Trading SymbolLumen Technologies, Inc. [LUMN] |
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
__X__ Director _____ 10% Owner __X__ Officer (give title below) _____ Other (specify below) President & CEO |
(Last)
(First)
(Middle)
100 CENTURYLINK DRIVE | 3. Statement for Issuer's Fiscal Year Ended (MM/DD/YYYY) 12/31/2021 |
(Street)
MONROE, LA 71203
(City)
(State)
(Zip)
| 4. If Amendment, Date Original Filed(MM/DD/YYYY) | 6. Individual or Joint/Group Filing(Check Applicable Line)
_X_ Form Filed by One Reporting Person
___ Form Filed by More than One Reporting Person
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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. Trans. Date | 2A. Deemed Execution Date, if any | 3. Trans. Code (Instr. 8) | 4. Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) | 5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (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 |
Common Stock | 10/27/2021 | | G | 930000 (1) | D | $0.00 | 3597319 | D | |
Common Stock | 10/27/2021 | | G | 930000 (1) | A | $0.00 | 930000 | I | By Spouse |
Common Stock | 11/5/2021 | | G | 784000 (2) | D | $0.00 | 2813319 | D | |
Common Stock | 11/5/2021 | | G | 783999 (3) | D | $0.00 | 146001 | I | By Spouse |
Common Stock | | | | | | | 7102 | I | By 401(k) |
Common Stock | | | | | | | 261333 (3) | I | By JS 2021 Trust |
Common Stock | | | | | | | 261333 (3) | I | By RS 2021 Trust |
Common Stock | | | | | | | 261333 (3) | I | By SM 2021 Trust |
Common Stock | | | | | | | 784000 (2) | I | By SLS 2021 Trust |
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 Derivate Security (Instr. 3) | 2. Conversion or Exercise Price of Derivative Security | 3. Trans. Date | 3A. Deemed Execution Date, if any | 4. Trans. 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 (MM/DD/YYYY) | 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 at End of Issuer's Fiscal Year (Instr. 4) | 10. Ownership Form of Derivative Security: 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 |
Explanation of Responses: |
(1) | Represents a gift of securities by the Reporting Person to the Reporting Person's spouse. |
(2) | Represents a gift of shares from the Reporting Person to a family trust for the benefit of his spouse and her children, for which his spouse serves as sole trustee. |
(3) | Represents a gift of shares from the Reporting Person's spouse to three separate trusts, each of which is for the benefit of one of their children. The Reporting Person serves as sole trustee for each of the three trusts. |
Reporting Owners
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Reporting Owner Name / Address | Relationships |
Director | 10% Owner | Officer | Other |
STOREY JEFFREY K 100 CENTURYLINK DRIVE MONROE, LA 71203 | X |
| President & CEO |
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Signatures
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/s/ Gary Maxwell Cox, attorney-in-fact for Jeffrey K. Storey | | 2/11/2022 |
**Signature of Reporting Person | Date |
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