0000914190-19-000209.txt : 20190612 0000914190-19-000209.hdr.sgml : 20190612 20190612171353 ACCESSION NUMBER: 0000914190-19-000209 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20190610 FILED AS OF DATE: 20190612 DATE AS OF CHANGE: 20190612 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: KAMIN PETER H CENTRAL INDEX KEY: 0000937541 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-35629 FILM NUMBER: 19894265 MAIL ADDRESS: STREET 1: ONE AVERY STREET STREET 2: 17 B CITY: BOSTON STATE: MA ZIP: 02111 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 2019-06-10 0001552800 TILE SHOP HOLDINGS, INC. TTS 0000937541 KAMIN PETER H C/O TILE SHOP HOLDINGS, INC. 14000 CARLSON PARKWAY PLYMOUTH MN 55441 1 0 0 0 Common Stock 2019-06-10 4 P 0 4468 4.11 A 787329 D Common Stock 2019-06-11 4 P 0 2547 4.11 A 789876 D Common Stock 2019-06-10 4 P 0 5776 4.11 A 773327 I By Peter H. Kamin Revocable Trust Common Stock 2019-06-11 4 P 0 2661 4.11 A 775988 I By Peter H. Kamin Revocable Trust Common Stock 2019-06-10 4 P 0 3784 4.11 A 492167 I By Peter H. Kamin Childrens Trust Common Stock 2019-06-11 4 P 0 1348 4.11 A 493515 I By Peter H. Kamin Childrens Trust Common Stock 2019-06-10 4 P 0 972 4.11 A 216245 I By 3K Limited Partnership Common Stock 2019-06-11 4 P 0 444 4.11 A 216689 I By 3K Limited Partnership Common Stock 7453 I By Peter H. Kamin Family Foundation Common Stock 135361 I By Peter H. Kamin GST Trust Common Stock 100 I By Son Includes 11,086 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 10, 2019. These securities are owned by the Peter H. Kamin Revocable Trust dated February 2003. The reporting person is trustee of the trust. 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. These securities are owned by the Peter H. Kamin Childrens Trust dated March 1997. The reporting person is trustee of the trust. 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. These securities are owned by the 3K Limited Partnership. The reporting person is general partner of the limited partnership. 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. These securities are owned by the Peter H. Kamin Family Foundation. The reporting person is trustee of the foundation. 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. These securities are owned by the Peter H. Kamin GST Trust. The reporting person is trustee of the trust. 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. These securities are owned by reporting person's son. 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 Peter H. Kamin pursuant to Power of Attorney previously filed. 2019-06-12