0001104659-23-111101.txt : 20231024 0001104659-23-111101.hdr.sgml : 20231024 20231024161522 ACCESSION NUMBER: 0001104659-23-111101 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20231023 FILED AS OF DATE: 20231024 DATE AS OF CHANGE: 20231024 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: 231342862 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 tm2329081-1_4seq1.xml OWNERSHIP DOCUMENT X0508 4 2023-10-23 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 0 Common Stock 2023-10-23 4 F 0 4397 5.07 D 121210 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 The reporting person has elected to satisfy his tax withholding obligation in connection with the vesting of a prior restricted stock grant by directing the Issuer to withhold shares otherwise issuable upon vesting of the previously reported grant. Includes (i) 3,561 shares of restricted stock for which the risks of forfeiture will lapse on 3/16/24; (ii) 2,540 shares of restricted stock for which the risks of forfeiture will lapse on 3/15/24; (iii) 5,137 shares of restricted stock for which the risks of forfeiture will lapse in equal annual installments on each of 3/7/24 and 3/7/25; (iv) 9,260 shares of restricted stock for which the risks of forfeiture will lapse in equal annual installments on each of 3/6/24, 3/6/25 and 3/6/26; 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 through 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 for which the risks of forfeiture will lapse on the date the Issuer files its annual report for the 2023 fiscal year; (B) 10,788 shares 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 the Issuer files its annual report for the 2023 and 2024 fiscal years, respectively; and (C) 18,519 shares for which the risks of forfeiture will lapse as to 30%, 30% and 40% on each of the dates the Issuer files its annual report for the 2023, 2024 and 2025 fiscal years, respectively. The Issuer's proxy statement contains additional information regarding the applicable performance targets. Fully exercisable. /s/ Mark B. Davis 2023-10-24