0000914190-16-000791.txt : 20160824 0000914190-16-000791.hdr.sgml : 20160824 20160824174432 ACCESSION NUMBER: 0000914190-16-000791 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20160822 FILED AS OF DATE: 20160824 DATE AS OF CHANGE: 20160824 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: 763-852-2978 MAIL ADDRESS: STREET 1: 14000 CARLSON PARKWAY CITY: PLYMOUTH STATE: MN ZIP: 55441 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: LIVINGSTON PHILIP B CENTRAL INDEX KEY: 0001020149 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-ADVERTISING AGENCIES [7311] STATE OF INCORPORATION: DE FISCAL YEAR END: 0331 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-35629 FILM NUMBER: 161850088 MAIL ADDRESS: STREET 1: 1241 EAST MAIN ST CITY: STAMFORD STATE: CT ZIP: 06902 4 1 edgar.xml PRIMARY DOCUMENT X0306 4 2016-08-22 0001552800 TILE SHOP HOLDINGS, INC. TTS 0001020149 LIVINGSTON PHILIP B C/O TILE SHOP HOLDINGS, INC. 14000 CARLSON PARKWAY PLYMOUTH MN 55441 1 0 0 0 Common Stock 2016-08-22 4 A 0 8323 0 A 15461 D Represents 8,323 shares of restricted stock granted pursuant to the Company's 2012 Omnibus Award Plan, which are subject to a purchase option in favor of the Company until the earlier of (a) the date of the Company's next annual meeting of stockholders and (2) August 22, 2017. /s/ Amanda Lorentz as Attorney-in-Fact for Philip B. Livingston pursuant to Power of Attorney previously filed. 2016-08-24