0001104659-21-094503.txt : 20210721
0001104659-21-094503.hdr.sgml : 20210721
20210721173353
ACCESSION NUMBER: 0001104659-21-094503
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20210720
FILED AS OF DATE: 20210721
DATE AS OF CHANGE: 20210721
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: BONNEY MARK J
CENTRAL INDEX KEY: 0001232607
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-35629
FILM NUMBER: 211105386
MAIL ADDRESS:
STREET 1: 2711 N. HASKELL AVENUE
STREET 2: SUITE 2300
CITY: DALLAS
STATE: TX
ZIP: 74204
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: 763-852-2950
MAIL ADDRESS:
STREET 1: 14000 CARLSON PARKWAY
CITY: PLYMOUTH
STATE: MN
ZIP: 55441
4
1
tm2122874-5_4seq1.xml
OWNERSHIP DOCUMENT
X0306
4
2021-07-20
0
0001552800
TILE SHOP HOLDINGS, INC.
TTSH
0001232607
BONNEY MARK J
C/O TILE SHOP HOLDINGS, INC.
14000 CARLSON PARKWAY
PLYMOUTH
MN
55441
1
0
0
0
Common Stock
2021-07-20
4
A
0
17624
0
A
60764
D
Represents 17,624 shares of restricted stock granted pursuant to the Company's 2012 Omnibus Award Plan, which are subject to a risk of forfeiture until the earlier of (a) the date of the Company's next annual meeting of stockholders and (b) July 20, 2022.
/s/ Mark Davis as Attorney-in-Fact for Mark J. Bonney pursuant to Power of Attorney
2021-07-21