SEC Form 4 · accession 0000914190-17-000155
TILE SHOP HOLDINGS, INC. · TTS
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Kirk Geadelmann
Officer — Chief Financial Officer
Period of report
May 11, 2017
Accepted (ET)
May 15, 2017 · 4:58 pm EDT
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 | May 11, 2017 | A | 3,000 | $0.00 | A | 9,070 | D | |
| Common StockF2,F3 | May 11, 2017 | A | 3,000 | $0.00 | A | 12,070 | D |
Table II — derivative securities
| Security | Conv. / exercise price | Date | Code | Shares | A/D | Exercisable | Expires | Underlying | Underlying shares | Owned after | D/I |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Stock Option (Right to Buy)F6 | $20.35 | May 11, 2017 | A | 13,200 | A | — | May 11, 2027 | Common Stock | 13,200 | 13,200 | D |
| Stock Option (Right to Buy)F4 | $10.93 | holding | — | — | — | — | Aug 12, 2021 | Common Stock | 100,000 | 100,000 | D |
| Stock Option (Right to Buy)F5 | $18.15 | holding | — | — | — | — | Apr 20, 2026 | Common Stock | 12,500 | 12,500 | D |
Explanation of responses
- F1Represents 3,000 shares of restricted stock for which the Company's purchase option will lapse in installments of 750 shares on each of May 11, 2018, May 11, 2019, May 11, 2020 and May 11, 2021.
- F2Represents 3,000 shares of performance-based restricted stock for which the Company's purchase option will lapse on May 11, 2020 based on the Company's achievement of its three-year adjusted EBITDA target.
- F3Includes (i) 5,200 shares of restricted stock for which the Company's purchase option will lapse in equal installments of 1,300 shares on each of April 20, 2018, April 20, 2019, April 20, 2020 and April 20, 2021; (ii) 3,000 shares of restricted stock for which the Company's purchase option will lapse in installments of 750 shares on each of May 11, 2018, May 11, 2019, May 11, 2020 and May 11, 2021; and (iii) 3,000 shares of performance-based restricted stock for which the Company's purchase option will lapse on May 11, 2020 based on the Company's achievement of its three-year adjusted EBITDA target.
- F4Options to purchase 20,000 shares vest on each of August 12, 2015, August 12, 2016, August 12, 2017, August 12, 2018 and August 12, 2019.
- F5Options to purchase 2,500 shares vest on each of April 20, 2017, April 20, 2018, April 20, 2019, April 20, 2020 and April 20, 2021.
- F6Options to purchase 3,300 shares vest on each of May 11, 2018, May 11, 2019, May 11, 2020 and May 11, 2021.