0000914190-14-000454.txt : 20141113
0000914190-14-000454.hdr.sgml : 20141113
20141113175248
ACCESSION NUMBER: 0000914190-14-000454
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20141111
FILED AS OF DATE: 20141113
DATE AS OF CHANGE: 20141113
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: TILE SHOP HOLDINGS, INC.
CENTRAL INDEX KEY: 0001552800
STANDARD INDUSTRIAL CLASSIFICATION: RETAIL-HOME FURNITURE, FURNISHINGS & EQUIPMENT STORES [5700]
IRS NUMBER: 455538095
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 14000 CARLSON PARKWAY
CITY: PLYMOUTH
STATE: MN
ZIP: 55441
BUSINESS PHONE: 763-852-2978
MAIL ADDRESS:
STREET 1: 14000 CARLSON PARKWAY
CITY: PLYMOUTH
STATE: MN
ZIP: 55441
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: KAMIN PETER H
CENTRAL INDEX KEY: 0000937541
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-35629
FILM NUMBER: 141219572
MAIL ADDRESS:
STREET 1: ONE AVERY STREET
STREET 2: 17 B
CITY: BOSTON
STATE: MA
ZIP: 02111
4
1
edgar.xml
PRIMARY DOCUMENT
X0306
4
2014-11-11
0001552800
TILE SHOP HOLDINGS, INC.
TTS
0000937541
KAMIN PETER H
C/O TILE SHOP HOLDINGS, INC.
14000 CARLSON PARKWAY
PLYMOUTH
MN
55441
1
0
0
0
Common Stock
2014-11-11
4
P
0
50000
8.38
A
314954
D
Common Stock
2014-11-12
4
P
0
5086
8.35
A
320040
D
Common Stock
379059
I
By Peter H. Kamin Revocable Trust
Common Stock
218335
I
By Peter H. Kamin Childrens Trust
Common Stock
160723
I
By 3K Limited Partnership
Common Stock
135361
I
By Peter H. Kamin GST Trust
Common Stock
100
I
By Son
Includes 9,270 shares of restricted stock (previously reported) granted pursuant to the Company's 2012 Omnibus Award Plan, which are subject to a purchase option in favor of the Company until August 21, 2015.
These securities are owned by the Peter H. Kamin Revocable Trust dated February 2003. The reporting person is trustee of the trust. The reporting person disclaims beneficial ownership of these securities except to the extent of his pecuniary interest therein, and this report shall not be deemed an admission that the reporting person is the beneficial owner of such securities for Section 16 or any other purpose.
These securities are owned by the Peter H. Kamin Childrens Trust dated March 1997. The reporting person is trustee of the trust. The reporting person disclaims beneficial ownership of these securities except to the extent of his pecuniary interest therein, and this report shall not be deemed an admission that the reporting person is the beneficial owner of such securities for Section 16 or any other purpose.
These securities are owned by the 3K Limited Partnership. The reporting person is general partner of the limited partnership. The reporting person disclaims beneficial ownership of these securities except to the extent of his pecuniary interest therein, and this report shall not be deemed an admission that the reporting person is the beneficial owner of such securities for Section 16 or any other purpose.
These securities are owned by the Peter H. Kamin GST Trust. The reporting person is trustee of the trust. The reporting person disclaims beneficial ownership of these securities except to the extent of his pecuniary interest therein, and this report shall not be deemed an admission that the reporting person is the beneficial owner of such securities for Section 16 or any other purpose.
These securities are owned by reporting person's son. The reporting person disclaims beneficial ownership of these securities except to the extent of his pecuniary interest therein, and this report shall not be deemed an admission that the reporting person is the beneficial owner of such securities for Section 16 or any other purpose.
/s/ John R. Houston as Attorney-in-Fact for Peter H. Kamin pursuant to Power of Attorney previously filed.
2014-11-13