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