SEC Form 3
FORM 3 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

INITIAL STATEMENT OF 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
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1. Name and Address of Reporting Person*
Clark Douglas S Jr

(Last) (First) (Middle)
4901 BAKERS MILL LANE

(Street)
RICHMOND VA 23230

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
12/08/2021
3. Issuer Name and Ticker or Trading Symbol
Lumber Liquidators Holdings, Inc. [ LL ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director 10% Owner
X Officer (give title below) Other (specify below)
SVP Merch & Supply Chain
5. 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 Beneficially Owned
1. Title of Security (Instr. 4) 2. Amount of Securities Beneficially Owned (Instr. 4) 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 4. Nature of Indirect Beneficial Ownership (Instr. 5)
Common Stock 23,311 D
Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 4) 2. Date Exercisable and Expiration Date (Month/Day/Year) 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) 4. Conversion or Exercise Price of Derivative Security 5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 6. Nature of Indirect Beneficial Ownership (Instr. 5)
Date Exercisable Expiration Date Title Amount or Number of Shares
Stock Option (right to purchase) (1) 02/24/2027 Common Stock 4,315 $17.39 D
Stock Option (right to purchase) (2) 03/02/2028 Common Stock 1,158 $23.31 D
Stock Option (right to purchase) (3) 02/28/2030 Common Stock 4,303 $9.8 D
Stock Option (right to purchase) (4) 08/07/2030 Common Stock 4,212 $21.3 D
Stock Option (right to purchase) (5) 03/05/2031 Common Stock 9,398 $23.55 D
Explanation of Responses:
1. Stock option vested at the rate of 25% per year over four years beginning on February 24, 2018.
2. Stock option vests at the rate of 25% per year over four years beginning on March 2, 2019.
3. Stock option vests at the rate of 25% per year over four years beginning on February 28, 2021.
4. Stock option vests at the rate of 25% per year over four years beginning on August 7, 2021.
5. Stock option vests at the rate of 25% per year over four years beginning on March 5, 2022.
/s/ Alice G. Givens, attorney-in-fact 12/15/2021
** 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 5 (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.
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number.