0001104659-22-030466.txt : 20220304 0001104659-22-030466.hdr.sgml : 20220304 20220304121756 ACCESSION NUMBER: 0001104659-22-030466 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20220303 FILED AS OF DATE: 20220304 DATE AS OF CHANGE: 20220304 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: KINDER JOSEPH CENTRAL INDEX KEY: 0001555217 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-35629 FILM NUMBER: 22713058 MAIL ADDRESS: STREET 1: C/O THE TILE SHOP, INC. STREET 2: 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 tm228436-3_4seq1.xml OWNERSHIP DOCUMENT X0306 4 2022-03-03 0 0001552800 TILE SHOP HOLDINGS, INC. TTSH 0001555217 KINDER JOSEPH C/O TILE SHOP HOLDINGS, INC. 14000 CARLSON PARKWAY PLYMOUTH MN 55441 0 1 0 0 See Remarks Common Stock 2022-03-03 4 D 0 4565 0 D 70927 D Common Stock 1100 I By Spouse Stock Option (Right to Buy) 8.5 2027-11-06 Common Stock 26900 26900 D Stock Option (Right to Buy) 8.8 2028-07-20 Common Stock 50000 50000 D Represents forfeiture of unvested performance-based restricted stock as a result of the applicable performance target not being achieved. Includes (i) 42,741 shares of restricted stock for which the risks of forfeiture will lapse as to 14,247 shares on each of 3/16/22, 3/16/23 and 3/16/24; (ii) 7,607 shares of restricted stock for which the risks of forfeiture will lapse as to 2,535 shares on 3/15/22 and 2,536 shares on each of 3/15/23 and 3/15/24; and (iii) 10,649 shares of performance-based restricted stock for which the risks of forfeiture will lapse in three installments of 4,564 and 6,085 on each of the dates that the Issuer files its annual report for the years ending December 31, 2022 and 2023, respectively, subject to Mr. Kinder remaining in continuous employment with the Issuer prior to and as of December 31 of the year preceding the applicable vesting date and the Issuer achieving its performance target for each respective year. Fully exercisable. SVP, Supply Chain & Distribution /s/ Joseph Kinder 2022-03-04