0001104659-23-029141.txt : 20230306 0001104659-23-029141.hdr.sgml : 20230306 20230306182457 ACCESSION NUMBER: 0001104659-23-029141 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: Lolmaugh Cabell CENTRAL INDEX KEY: 0001731797 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-35629 FILM NUMBER: 23710363 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 tm238679-3_4seq1.xml OWNERSHIP DOCUMENT X0306 4 2023-03-02 0 0001552800 TILE SHOP HOLDINGS, INC. TTSH 0001731797 Lolmaugh Cabell C/O TILE SHOP HOLDINGS, INC. 14000 CARLSON PARKWAY PLYMOUTH MN 55441 1 1 0 0 Chief Executive Officer Common Stock 2023-03-02 4 D 0 18375 0 D 186752 D Stock Option (Right to Buy) 8.5 2027-11-06 Common Stock 26900 26900 D Stock Option (Right to Buy) 5.55 2028-02-22 Common Stock 56000 56000 D Stock Option (Right to Buy) 6.26 2029-02-20 Common Stock 97067 97067 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) 56,988 shares of restricted stock for which the risks of forfeiture will lapse as to 28,494 shares on each of 3/16/23 and 3/16/24; (ii) 10,147 shares of restricted stock for which the risks of forfeiture will lapse as to 5,066 shares on 3/15/23 and 5,081 shares on 3/15/24; (iii) 15,411 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 (iv) the following shares of performance-based restricted stock, which are, in each case, subject to Mr. Lolmaugh 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) 12,171 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) 21,576 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/ Cabell Lolmaugh 2023-03-06