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