SEC Form 4 · accession 0001209191-16-155179
TILLY'S, INC. · TLYS
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Hezy Shaked
Officer — Chief Strategy Officer · Director · 10% Owner
Period of report
Dec 12, 2016
Accepted (ET)
Dec 14, 2016 · 4:45 pm EST
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0001524025
Table I — non-derivative securities
| Security | Date | Code | Shares | Price | A/D | Owned after | D/I | Nature of ownership |
|---|---|---|---|---|---|---|---|---|
| CLASS A COMMON STOCKF1 | Dec 12, 2016 | C | 10,000 | $0.00 | A | 10,000 | D | |
| CLASS A COMMON STOCKF3 | Dec 12, 2016 | S | 10,000 | $15.0318 | D | 0 | D | |
| CLASS A COMMON STOCKF1 | Dec 13, 2016 | C | 10,000 | $0.00 | A | 10,000 | D | |
| CLASS A COMMON STOCKF4 | Dec 13, 2016 | S | 10,000 | $14.7163 | D | 0 | D | |
| CLASS A COMMON STOCKF5 | holding | — | — | — | 725,611 | I | BY LLC |
Table II — derivative securities
| Security | Conv. / exercise price | Date | Code | Shares | A/D | Exercisable | Expires | Underlying | Underlying shares | Owned after | D/I |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Class B Common StockF1,F6 | — | Dec 12, 2016 | C | 10,000 | D | — | — | Class A Common Stock | 10,000 | 9,458,405 | D |
| Class B Common StockF1,F6 | — | Dec 13, 2016 | C | 10,000 | D | — | — | Class A Common Stock | 10,000 | 9,448,405 | D |
Explanation of responses
- F1The shares reported herein are held in The Hezy Shaked Living Trust under which the Reporting Person is trustee and beneficiary. Pursuant to a voting trust agreement with Tilly Levine, the Reporting Person has the right to vote certain shares of Class A Common Stock and Class B Common Stock held by Tilly Levine (the "Levine Shares"). Tilly Levine has filed a Form 3 and subsequent Forms 4 with respect to the Levine Shares. The Reporting Person does not have any pecuniary interest in the Levine Shares and thus disclaims beneficial ownership of such shares.
- F2The sales reported in this Form 4 were effected pursuant to a 10b5-1 trading plan adopted by The Hezy Shaked Living Trust, of which the Reporting Person is trustee and beneficiary, on September 30, 2016 in accordance with Rule 10b5-1 of the Securities Exchange Act of 1934, as amended.
- F3The price reported in Column 4 is a weighted average price. These shares were sold in multiple transactions at prices ranging from $14.57 to $15.25, inclusive. The Reporting Person undertakes to provide to the Issuer, any security holder of the Issuer, or the staff of the Securities and Exchange Commission, upon request, full information regarding the number of shares sold at each separate price within the ranges set forth in this footnote.
- F4The price reported in Column 4 is a weighted average price. These shares were sold in multiple transactions at prices ranging from $14.25 to $14.96, inclusive. The Reporting Person undertakes to provide to the Issuer, any security holder of the Issuer, or the staff of the Securities and Exchange Commission, upon request, full information regarding the number of shares sold at each separate price within the ranges set forth in this footnote.
- F5Represents shares held by a limited liability company (the "LLC") of which the Reporting Person serves as the sole manager with sole voting and investment control over the securities held thereby. The Reporting Person disclaims beneficial ownership of the securities held by the LLC except to the extent of his pecuniary interest therein.
- F6Class B Common Stock has no expiration date and is convertible on a one-for-one basis into shares of Class A Common Stock at the election of the holder or automatically upon the occurrence of certain events.