0001181431-12-029238.txt : 20120510 0001181431-12-029238.hdr.sgml : 20120510 20120510195322 ACCESSION NUMBER: 0001181431-12-029238 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20120509 FILED AS OF DATE: 20120510 DATE AS OF CHANGE: 20120510 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: SHAKED HEZY CENTRAL INDEX KEY: 0001548777 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-35535 FILM NUMBER: 12831909 MAIL ADDRESS: STREET 1: C/O TILLY'S, INC. STREET 2: 10 WHATNEY CITY: IRVINE STATE: CA ZIP: 92618 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: TILLY'S, INC. CENTRAL INDEX KEY: 0001524025 STANDARD INDUSTRIAL CLASSIFICATION: RETAIL-APPAREL & ACCESSORY STORES [5600] IRS NUMBER: 452164791 STATE OF INCORPORATION: DE FISCAL YEAR END: 0131 BUSINESS ADDRESS: STREET 1: 10 WHATNEY CITY: IRVINE STATE: CA ZIP: 92618 BUSINESS PHONE: (949) 609-5599 MAIL ADDRESS: STREET 1: 10 WHATNEY CITY: IRVINE STATE: CA ZIP: 92618 4 1 rrd344654.xml SHAKED F4 X0305 4 2012-05-09 0 0001524025 TILLY'S, INC. TLYS 0001548777 SHAKED HEZY C/O TILLY'S, INC. 10 WHATNEY IRVINE CA 92618 1 1 1 0 CHIEF STRATEGY OFFICER CLASS A COMMON STOCK 2012-05-09 4 C 0 800000 0 A 800000 D CLASS A COMMON STOCK 2012-05-09 4 S 0 800000 14.415 D 0 D CLASS B COMMON STOCK 2012-05-09 4 C 0 800000 0 D CLASS A COMMON STOCK 800000 9200000 D The shares reported herein are held in The Hezy Shaked Living Trust under which the Reporting Person is trustee and beneficiary. The Reporting Person is also deemed the beneficial owner of shares held by Tilly Levine (the "Levine Shares") due to certain voting rights. The Reporting Person has jointly filed a Form 3 on the Levine Shares, but has no pecuniary interest in the Levine Shares. Class B Common Stock has no expiration date and, subject to certain events, is automatically convertible on a one-for-one basis into shares of Class A Common Stock. The shares of Class B Common Stock reported on this line item converted into the Issuer's Class A Common Stock on a one-for-one basis upon the closing of the Issuer's initial public offering and sale to the underwriters. Represents the public offering price of $15.50 per share of Class A Common Stock less the underwriter's discount of $1.085 per share of Class A Common Stock. /s/ PATRICK GROSSO, ATTORNEY-IN-FACT FOR HEZY SHAKED 2012-05-10