0001104659-23-071696.txt : 20230615
0001104659-23-071696.hdr.sgml : 20230615
20230615174639
ACCESSION NUMBER: 0001104659-23-071696
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20230613
FILED AS OF DATE: 20230615
DATE AS OF CHANGE: 20230615
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Kamin Peter
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: 231018699
MAIL ADDRESS:
STREET 1: 2720 DONALD ROSS ROAD
STREET 2: #311
CITY: PALM BEACH GARDENS
STATE: FL
ZIP: 33410
FORMER NAME:
FORMER CONFORMED NAME: KAMIN PETER H
DATE OF NAME CHANGE: 19950210
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
tm2318831-4_4seq1.xml
OWNERSHIP DOCUMENT
X0407
4
2023-06-13
0
0001552800
TILE SHOP HOLDINGS, INC.
TTSH
0000937541
Kamin Peter
C/O TILE SHOP HOLDINGS, INC
14000 CARLSON PARKWAY
PLYMOUTH
MN
55441
1
0
1
0
0
Common Stock
2023-06-13
4
A
0
38248
4.9677
A
3447632
D
Common Stock
1695320
I
By Peter H. Kamin Revocable Trust
Common Stock
1033733
I
By Peter H. Kamin Childrens Trust
Common Stock
333495
I
By 3K Limited Partnership
Common Stock
117453
I
By Peter H. Kamin Family Foundation
Common Stock
328711
I
By Peter H. Kamin GST Trust
Represents shares of restricted stock granted pursuant to the Company's 2021 Omnibus Equity Compensation 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) June 13, 2024.
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.
/s/ Mark Davis as Attorney-in-Fact for Peter H. Kamin pursuant to Power of Attorney
2023-06-15