0000921895-20-001117.txt : 20200416
0000921895-20-001117.hdr.sgml : 20200416
20200416160436
ACCESSION NUMBER: 0000921895-20-001117
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20200414
FILED AS OF DATE: 20200416
DATE AS OF CHANGE: 20200416
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: CRIVELLO JEFFERY
CENTRAL INDEX KEY: 0001715474
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-36803
FILM NUMBER: 20796398
MAIL ADDRESS:
STREET 1: 12701 WHITEWATER DRIVE, SUITE 200
CITY: MINNETONKA
STATE: MN
ZIP: 55343
FORMER NAME:
FORMER CONFORMED NAME: CRIVELLO JEFFREY
DATE OF NAME CHANGE: 20170824
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: TOWN SPORTS INTERNATIONAL HOLDINGS INC
CENTRAL INDEX KEY: 0001281774
STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-MEMBERSHIP SPORTS & RECREATION CLUBS [7997]
IRS NUMBER: 200640002
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 1001 US NORTH HIGHWAY 1
STREET 2: SUITE 201
CITY: JUPITER
STATE: FL
ZIP: 33477
BUSINESS PHONE: (212) 246-6700
MAIL ADDRESS:
STREET 1: 399 EXECUTIVE BOULEVARD
CITY: ELMSFORD
STATE: NY
ZIP: 10523
4
1
form411125001_04162020.xml
OWNERSHIP DOCUMENT
X0306
4
2020-04-14
0
0001281774
TOWN SPORTS INTERNATIONAL HOLDINGS INC
CLUB
0001715474
CRIVELLO JEFFERY
235 WALNUT STREET
LIBERTYVILLE
IL
60048
1
0
0
0
Common Stock, par value $0.001
2020-04-14
4
A
0
228571
0.00
A
428994
D
Represents shares of restricted stock of the Issuer issued to the Reporting Person under the Issuer's Amended and Restated 2006 Stock Incentive Plan. The shares of restricted stock will vest in three equal annual installments commencing on April 14, 2021, the first anniversary of the grant date.
/s/ Jeffery Crivello
2020-04-16