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