SEC Form 4 · accession 0001209191-16-155920
TILLY'S, INC. · TLYS
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Tilly Levine
10% Owner
Period of report
Dec 16, 2016
Accepted (ET)
Dec 19, 2016 · 4:32 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 16, 2016 | C | 5,000 | $0.00 | A | 5,000 | I | By Trust 1 |
| Class A Common StockF3 | Dec 16, 2016 | S | 5,000 | $13.9983 | D | 0 | I | By Trust 1 |
| Class A Common StockF1 | Dec 16, 2016 | C | 5,000 | $0.00 | A | 5,000 | I | By Trust 2 |
| Class A Common StockF4 | Dec 16, 2016 | S | 5,000 | $13.9983 | D | 0 | I | By Trust 2 |
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 StockF6,F5 | — | Dec 16, 2016 | C | 5,000 | D | — | — | Class A Common Stock | 5,000 | 409,386 | I |
| Class B Common StockF6,F5 | — | Dec 16, 2016 | C | 5,000 | D | — | — | Class A Common Stock | 5,000 | 409,386 | I |
| Class B Common StockF5 | — | holding | — | — | — | — | — | Class A Common Stock | 4,363,147 | 4,363,147 | D |
Explanation of responses
- F1Represents shares of Class A Common Stock held by trusts of which the Reporting Person is trustee and an immediate family member is the beneficiary. The Reporting Person disclaims beneficial ownership of such shares except to the extent of her pecuniary interest therein, if any.
- F2The sales reported in this Form 4 were effected pursuant to a 10b5-1 trading plan adopted by the trust, of which the Reporting Person is trustee and an immediate family member is the beneficiary, on April 1, 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 $13.78 to $14.34, 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 $13.78 to $14.36, 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.
- F5Class B Common Stock has no expiration date and, subject to certain events, is automatically convertible on a one-for-one basis into shares of Class A Common Stock.
- F6Represents shares of Class B Common Stock held by trusts of which the Reporting Person is trustee and an immediate family member is the beneficiary. The Reporting Person disclaims beneficial ownership of such shares except to the extent of her pecuniary interest therein, if any.