0001104659-22-035026.txt : 20220317 0001104659-22-035026.hdr.sgml : 20220317 20220317161540 ACCESSION NUMBER: 0001104659-22-035026 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20220315 FILED AS OF DATE: 20220317 DATE AS OF CHANGE: 20220317 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: 22748709 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 tm229624d1_4seq1.xml OWNERSHIP DOCUMENT X0306 4 2022-03-15 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 2022-03-15 4 F 0 761 6.54 D 116235 D Common Stock 2022-03-16 4 F 0 1098 6.61 D 115137 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) 14.19 2022-07-14 Common Stock 2737 2737 D Stock Option (Right to Buy) 8.5 2027-11-06 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) 1,598 shares of restricted stock for which the risks of forfeiture will lapse on 2/20/23; (ii) 28,736 shares of restricted stock for which the risks of forfeiture will lapse as to 14,368 shares on each of 10/23/22 and 10/23/23; (iii) 7,123 shares of restricted stock for which the risks of forfeiture will lapse as to 3,562 shares on 3/16/23 and 3,561 shares on 3/16/24; (iv) 5,073 shares of restricted stock for which the risks of forfeiture will lapse as to 2,533 shares on 3/15/23 and 2,540 shares on 3/15/24; (v) 7,706 shares of restricted stock for which the risks of forfeiture will lapse in three equal annual installments on each of 3/7/23, 3/7/24 and 3/7/25; and (vi) the following shares of performance-based restricted stock, which are, in each case, subject to Mr. Davis remaining in continuous employment with the Issuer prior to and as of December 31 of the year preceding the applicable vesting date and the Issuer achieving its performance target for each respective year: (A) 10,649 shares of performance-based restricted stock for which the risks of forfeiture will lapse as to 4,564 and 6,085 shares on each of the dates that the Issuer files its annual report for the years ending December 31, 2022 and 2023, respectively, and (B) 15,411 shares of performance-based restricted stock for which the risks of forfeiture will lapse as to 30%, 30% and 40% of the shares on each of the dates that the Issuer files its annual report for the years ending December 31, 2022, 2023 and 2024, respectively. The Issuer's proxy statement contains additional information regarding the applicable performance targets. Fully exercisable. /s/ Mark B. Davis 2022-03-17