SEC Form 5 · accession 0000914190-17-000049
TILE SHOP HOLDINGS, INC. · TTS
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Robert A Rucker
Director · 10% Owner
Period of report
Dec 31, 2016
Accepted (ET)
Feb 14, 2017 · 5:35 pm EST
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0001552800
Table I — non-derivative securities
| Security | Date | Code | Shares | Price | A/D | Owned after | D/I | Nature of ownership |
|---|---|---|---|---|---|---|---|---|
| Common StockF1 | Dec 2, 2016 | G | 11,140 | $0.00 | D | 251,387 | D | |
| Common Stock | Dec 2, 2016 | G | 1,430 | $0.00 | A | 1,430 | I | By Spouse |
| Common Stock | Dec 2, 2016 | G | 1,430 | $0.00 | A | 1,430 | I | By UGMA #1 |
| Common Stock | Dec 2, 2016 | G | 1,430 | $0.00 | A | 1,430 | I | By UGMA #2 |
| Common Stock | Dec 2, 2016 | G | 1,430 | $0.00 | A | 1,430 | I | By UGMA #3 |
| Common Stock | Dec 2, 2016 | G | 1,430 | $0.00 | A | 1,430 | I | By UGMA #4 |
| Common Stock | Dec 2, 2016 | G | 1,430 | $0.00 | A | 1,430 | I | By UGMA #5 |
| Common Stock | Dec 2, 2016 | G | 1,430 | $0.00 | A | 1,430 | I | By UGMA #6 |
| Common Stock | Dec 2, 2016 | G | 1,430 | $0.00 | A | 1,430 | I | By UGMA #7 |
| Common Stock | holding | — | — | — | 2,800,000 | I | By Grantor Retained Annuity Trust | |
| Common StockF2 | holding | — | — | — | 2,852,428 | I | By The Tile Shop, Inc. |
Table II — derivative securities
No Table II lines on this filing.
Explanation of responses
- F1Includes 5,622 shares of restricted stock granted pursuant to the Company's 2012 Omnibus Award Plan, which are subject to a purchase option in favor of the Company until the earlier of (a) the date of the Company's next annual meeting of stockholders and (2) August 22, 2017.
- F2These securities are owned by The Tile Shop, Inc. ("TTS"). The reporting person is the sole director of TTS.