0000921895-19-000225.txt : 20190205 0000921895-19-000225.hdr.sgml : 20190205 20190205204124 ACCESSION NUMBER: 0000921895-19-000225 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20190121 FILED AS OF DATE: 20190205 DATE AS OF CHANGE: 20190205 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Ajmera Nitin CENTRAL INDEX KEY: 0001607717 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-36803 FILM NUMBER: 19569632 MAIL ADDRESS: STREET 1: 5 PENN PLAZA CITY: NEW YORK STATE: NY ZIP: 10001 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: TOWN SPORTS INTERNATIONAL HOLDINGS INC CENTRAL INDEX KEY: 0001281774 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-MEMBERSHIP SPORTS & RECREATION CLUBS [7997] IRS NUMBER: 200640002 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 1001 US NORTH HIGHWAY 1 STREET 2: SUITE 201 CITY: JUPITER STATE: FL ZIP: 33477 BUSINESS PHONE: (212) 246-6700 MAIL ADDRESS: STREET 1: 399 EXECUTIVE BOULEVARD CITY: ELMSFORD STATE: NY ZIP: 10523 4 1 form411125ajm_02052019.xml OWNERSHIP DOCUMENT X0306 4 2019-01-21 0 0001281774 TOWN SPORTS INTERNATIONAL HOLDINGS INC CLUB 0001607717 Ajmera Nitin 1001 US NORTH HIGHWAY 1, SUITE 201 JUPITER FL 33477 0 1 0 0 SVP - Controller Common Stock, par value $0.001 2019-01-21 4 A 0 20000 0.00 A 53586 D Represents shares of restricted stock that were issued to Mr. Ajmera under the Issuer's Amended and Restated 2006 Stock Incentive Plan. The shares of restricted stock will vest in three equal annual installments commencing on January 21, 2020, the first anniversary of the grant date. /s/ Nitin Ajmera 2019-02-05