0001181431-13-036499.txt : 20130624 0001181431-13-036499.hdr.sgml : 20130624 20130624204541 ACCESSION NUMBER: 0001181431-13-036499 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20130618 FILED AS OF DATE: 20130624 DATE AS OF CHANGE: 20130624 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: HS ANNUITY TRUST CENTRAL INDEX KEY: 0001548785 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-35535 FILM NUMBER: 13930706 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 rrd384275.xml HS ANNUITY TRUST F4 X0306 4 2013-06-18 0 0001524025 TILLY'S, INC. TLYS 0001548785 HS ANNUITY TRUST C/O TILLY'S, INC. 10 WHATNEY IRVINE CA 92618 0 0 1 0 CLASS A COMMON STOCK 2013-06-18 4 C 0 195 0 A 195 D CLASS A COMMON STOCK 2013-06-18 4 S 0 195 16.00 D 0 D CLASS B COMMON STOCK 2013-06-18 4 C 0 195 0 D CLASS A COMMON STOCK 195 1714466 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 reported on this line item converted into shares of the Issuer's Class A Common Stock on a one-for-one basis upon the election of the Reporting Person. /s/ Christopher M. Lal, Attorney-in-Fact for Netta Schroer and Amy Shaked, Co-Trustees of the HS Annuity Trust 2013-06-24