SEC Form 4 · accession 0000914190-17-000174
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
Jul 13, 2017
Accepted (ET)
Jul 17, 2017 · 5:21 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 | Jul 13, 2017 | A | 5,038 | $0.00 | A | 256,425 | D | |
| Common StockF2 | holding | — | — | — | 2,752,428 | I | By The Tile Shop, Inc. | |
| Common Stock | holding | — | — | — | 2,800,000 | I | By Grantor Retained Annuity Trust | |
| Common Stock | holding | — | — | — | 1,430 | I | By Spouse | |
| Common Stock | holding | — | — | — | 1,430 | I | By UGMA #1 | |
| Common Stock | holding | — | — | — | 1,430 | I | By UGMA #2 | |
| Common Stock | holding | — | — | — | 1,430 | I | By UGMA #3 | |
| Common Stock | holding | — | — | — | 1,430 | I | By UGMA #4 | |
| Common Stock | holding | — | — | — | 1,430 | I | By UGMA #5 | |
| Common Stock | holding | — | — | — | 1,430 | I | By UGMA #6 | |
| Common Stock | holding | — | — | — | 1,430 | I | By UGMA #7 |
Table II — derivative securities
No Table II lines on this filing.
Explanation of responses
- F1Represents 5,038 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) July 13, 2018.
- F2These securities are owned by The Tile Shop, Inc. The reporting person is the sole director of The Tile Shop, Inc. 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.