0001104659-23-029137.txt : 20230306
0001104659-23-029137.hdr.sgml : 20230306
20230306182314
ACCESSION NUMBER: 0001104659-23-029137
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20230302
FILED AS OF DATE: 20230306
DATE AS OF CHANGE: 20230306
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Davis Mark Burton
CENTRAL INDEX KEY: 0001787766
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-35629
FILM NUMBER: 23710353
MAIL ADDRESS:
STREET 1: C/O 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
tm238679-1_4seq1.xml
OWNERSHIP DOCUMENT
X0306
4
2023-03-02
0
0001552800
TILE SHOP HOLDINGS, INC.
TTSH
0001787766
Davis Mark Burton
C/O TILE SHOP HOLDINGS, INC
14000 CARLSON PARKWAY
PLYMOUTH
MN
55441
0
1
0
0
VP Inv. Relations & CAO
Common Stock
2023-03-02
4
D
0
9187
0
D
100979
D
Common Stock
820
I
By Child #1
Common Stock
775
I
By Child #2
Common Stock
765
I
By Child #3
Stock Option (Right to Buy)
8.5
2027-11-06
Common Stock
5400
5400
D
Represents forfeiture of unvested performance-based restricted stock granted in 2021 and 2022 as a result of the applicable performance targets not being achieved.
Includes (i) 14,368 shares of restricted stock for which the risk of forfeiture will lapse on 10/23/23; (ii) 7,123 shares of restricted stock for which the risks of forfeiture will lapse as to 3,562 shares on 3/16/23 and 3,561 shares on 3/16/24; (iii) 5,073 shares of restricted stock for which the risks of forfeiture will lapse as to 2,533 shares on 3/15/23 and 2,540 shares on 3/15/24; (iv) 7,706 shares of restricted stock for which the risks of forfeiture will lapse in three equal annual installments on each of 3/7/23, 3/7/24 and 3/7/25; and
(v) the following shares of performance-based restricted stock, which are, in each case, subject to Mr. Davis 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: (A) 6,085 shares of performance-based restricted stock for which the risks of forfeiture will lapse on the date that the Issuer files its annual report for the year ending December 31, 2023 and (B) 10,788 shares of performance-based restricted stock for which the risks of forfeiture will lapse as to 30% and 40% of the initial number of shares granted on each of the dates that the Issuer files its annual report for the years ending December 31, 2023 and 2024, respectively. The Issuer's proxy statement contains additional information regarding the applicable performance targets.
Fully exercisable.
/s/ Mark B. Davis
2023-03-06