0001104659-20-117887.txt : 20201023 0001104659-20-117887.hdr.sgml : 20201023 20201023204718 ACCESSION NUMBER: 0001104659-20-117887 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20201023 FILED AS OF DATE: 20201023 DATE AS OF CHANGE: 20201023 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Davis Mark Burton CENTRAL INDEX KEY: 0001787766 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-35629 FILM NUMBER: 201258840 MAIL ADDRESS: STREET 1: C/O 14000 CARLSON PARKWAY CITY: PLYMOUTH STATE: MN ZIP: 55441 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 tm2034216-1_4.xml OWNERSHIP DOCUMENT X0306 4 2020-10-23 0 0001552800 TILE SHOP HOLDINGS, INC. TTSH 0001787766 Davis Mark Burton C/O TILE SHOP HOLDINGS, INC. 14000 CARLSON PARKWAY PLYMOUTH MN 55441 0 1 0 0 VP Inv. Relations & CAO Common Stock 2020-10-23 4 F 0 4281 3.89 D 82354 D Common Stock 820 I By Child #1 Common Stock 775 I By Child #2 Common Stock 765 I By Child #3 Stock Option (Right to Buy) 8.58 2021-10-21 Common Stock 20000 20000 D Stock Option (Right to Buy) 14.19 2022-07-14 Common Stock 2737 2737 D Stock Option (Right to Buy) 8.5 2027-11-02 Common Stock 5400 5400 D The reporting person has elected to satisfy his tax withholding obligation in connection with the vesting of a prior restricted stock grant by directing the Issuer to withhold shares otherwise issuable upon vesting of the previously reported grant. Includes (i) 4,792 shares of restricted stock for which the risks of forfeiture will lapse as to 1,598 shares on 2/20/21 and as to 1,597 shares on each of 2/20/22 and 2/20/23; (ii) 43,104 shares of restricted stock for which the risks of forfeiture will lapse as to 14,368 shares on each of 10/23/21, 10/23/22 and 10/23/23; and (iii) 14,247 shares of restricted stock for which the risks of forfeiture will lapse as to 3,562 shares on each of 3/16/21, 3/16/22 and 3/16/23 and 3,561 shares on 3/16/24. Fully exercisable. Options to purchase 1,350 shares vest on each of 11/2/18, 11/2/19, 11/2/20 and 11/2/21. /s/ Mark Davis 2020-10-23