0001127602-21-017679.txt : 20210520
0001127602-21-017679.hdr.sgml : 20210520
20210520180016
ACCESSION NUMBER: 0001127602-21-017679
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20210519
FILED AS OF DATE: 20210520
DATE AS OF CHANGE: 20210520
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: BELGYA MARK R
CENTRAL INDEX KEY: 0001251529
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 000-19848
FILM NUMBER: 21945825
MAIL ADDRESS:
STREET 1: ONE STRAWBERRY LANE
CITY: ORRVILLE
STATE: OH
ZIP: 44667
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: Fossil Group, Inc.
CENTRAL INDEX KEY: 0000883569
STANDARD INDUSTRIAL CLASSIFICATION: WATCHES, CLOCKS, CLOCKWORK OPERATED DEVICES/PARTS [3873]
IRS NUMBER: 752018505
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1228
BUSINESS ADDRESS:
STREET 1: 901 S CENTRAL EXPRESSWAY
CITY: RICHARDSON
STATE: TX
ZIP: 75080
BUSINESS PHONE: 9722342525
MAIL ADDRESS:
STREET 1: 901 S CENTRAL EXPRESSWAY
CITY: RICHARDSON
STATE: TX
ZIP: 75080
FORMER COMPANY:
FORMER CONFORMED NAME: FOSSIL INC
DATE OF NAME CHANGE: 19940218
4
1
form4.xml
PRIMARY DOCUMENT
X0306
4
2021-05-19
0000883569
Fossil Group, Inc.
FOSL
0001251529
BELGYA MARK R
901 S CENTRAL EXPRESSWAY
RICHARDSON
TX
75080
1
Common Stock
2021-05-19
4
A
0
9969
0
A
29613
D
Restricted Stock Units that shall become one hundred percent (100%) vested and convertible into shares of Common Stock on the earlier of the first anniversary of the Date
of Grant or the first Annual Stockholders Meeting following the Date of Grant.
Consists of 9,969 Restricted Stock Units.
/s/ Randy S. Hyne, Attorney-in-Fact
2021-05-20