0000914190-19-000235.txt : 20190718
0000914190-19-000235.hdr.sgml : 20190718
20190718163408
ACCESSION NUMBER: 0000914190-19-000235
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20190716
FILED AS OF DATE: 20190718
DATE AS OF CHANGE: 20190718
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: RUCKER ROBERT A
CENTRAL INDEX KEY: 0001555206
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-35629
FILM NUMBER: 19961655
MAIL ADDRESS:
STREET 1: 14000 CARLSON PARKWAY
CITY: PLYMOUTH
STATE: MN
ZIP: 55441
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: TILE SHOP HOLDINGS, INC.
CENTRAL INDEX KEY: 0001552800
STANDARD INDUSTRIAL CLASSIFICATION: RETAIL-HOME FURNITURE, FURNISHINGS & EQUIPMENT STORES [5700]
IRS NUMBER: 455538095
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 14000 CARLSON PARKWAY
CITY: PLYMOUTH
STATE: MN
ZIP: 55441
BUSINESS PHONE: 763-852-2950
MAIL ADDRESS:
STREET 1: 14000 CARLSON PARKWAY
CITY: PLYMOUTH
STATE: MN
ZIP: 55441
4
1
edgar.xml
PRIMARY DOCUMENT
X0306
4
2019-07-16
0001552800
TILE SHOP HOLDINGS, INC.
TTS
0001555206
RUCKER ROBERT A
C/O TILE SHOP HOLDINGS, INC.
14000 CARLSON PARKWAY
PLYMOUTH
MN
55441
1
0
1
0
Common Stock
2019-07-16
4
A
0
24571
0
A
256396
D
Common Stock
3662428
I
By The Tile Shop, Inc.
Common Stock
775000
I
By 2017 Grantor Retained Annuity Trust
Common Stock
515000
I
By 2017 Grantor Retained Annuity Trust II
Common Stock
500000
I
By 2018 Grantor Retained Annuity Trust
Common Stock
3380
I
By Spouse
Common Stock
3380
I
By UGMA #1
Common Stock
3380
I
By UGMA #2
Common Stock
3380
I
By UGMA #3
Common Stock
3380
I
By UGMA #4
Common Stock
3380
I
By UGMA #5
Common Stock
3380
I
By UGMA #6
Common Stock
3380
I
By UGMA #7
Represents 24,571 shares of restricted stock granted pursuant to the Company's 2012 Omnibus Award Plan, which are subject to a risk of forfeiture until the earlier of (a) the date of the Company's next annual meeting of stockholders and (b) July 16, 2020.
These securities are owned by The Tile Shop, Inc. The reporting person is the sole director of The Tile Shop, Inc. The reporting person disclaims beneficial ownership of these securities except to the extent of his pecuniary interest therein, and this report shall not be deemed an admission that the reporting person is the beneficial owner of such securities for Section 16 or any other purpose.
/s/ Amanda Lorentz as Attorney-in-Fact for Robert Rucker pursuant to Power of Attorney previously filed.
2019-07-18