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