0001181431-12-029240.txt : 20120510 0001181431-12-029240.hdr.sgml : 20120510 20120510195522 ACCESSION NUMBER: 0001181431-12-029240 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20120509 FILED AS OF DATE: 20120510 DATE AS OF CHANGE: 20120510 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 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: TL ANNUITY TRUST CENTRAL INDEX KEY: 0001548782 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-35535 FILM NUMBER: 12831912 BUSINESS ADDRESS: STREET 1: C/O TILLY'S, INC. STREET 2: 10 WHATNEY CITY: IRVINE STATE: CA ZIP: 92618 BUSINESS PHONE: (949) 609-5599 MAIL ADDRESS: STREET 1: C/O TILLY'S, INC. STREET 2: 10 WHATNEY CITY: IRVINE STATE: CA ZIP: 92618 4 1 rrd344662.xml TLANNUITY F4 X0305 4 2012-05-09 1 0001524025 TILLY'S, INC. TLYS 0001548782 TL ANNUITY TRUST C/O TILLY'S, INC. 10 WHATNEY IRVINE CA 92618 0 0 1 0 CLASS A COMMON STOCK 2012-05-09 4 C 0 160000 0 A 160000 D CLASS A COMMON STOCK 2012-05-09 4 S 0 160000 14.415 D 0 D CLASS B COMMON STOCK 2012-05-09 4 C 0 160000 0 D CLASS A COMMON STOCK 160000 1840000 D 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 NETTA SCHROER AND AMY SHAKED, CO-TRUSTEES OF THE TL ANNUITY TRUST 2012-05-10