SEC Form 5 · accession 0000914190-19-000026
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, 2018
Accepted (ET)
Feb 14, 2019 · 4:59 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 Stock | Sep 25, 2018 | G | 500,000 | $0.00 | D | 0 | I | By 2016 Grantor Retained Annuity Trust |
| Common StockF1 | Sep 25, 2018 | G | 500,000 | $0.00 | A | 652,428 | I | By The Tile Shop, Inc. |
| Common StockF1 | Sep 25, 2018 | G | 500,000 | $0.00 | D | 152,428 | I | By The Tile Shop, Inc. |
| Common Stock | Sep 25, 2018 | G | 500,000 | $0.00 | A | 500,000 | I | By 2018 Grantor Retained Annuity Trust |
| Common Stock | Oct 11, 2018 | G | 1,225,000 | $0.00 | D | 775,000 | I | By 2017 Grantor Retained Annuity Trust |
| Common StockF1 | Oct 11, 2018 | G | 1,225,000 | $0.00 | A | 1,877,428 | I | By The Tile Shop, Inc. |
| Common Stock | Dec 20, 2018 | G | 1,785,000 | $0.00 | D | 515,000 | I | By 2017 Grantor Retained Annuity Trust II |
| Common StockF1 | Dec 20, 2018 | G | 1,785,000 | $0.00 | A | 3,662,428 | I | By The Tile Shop, Inc. |
Table II — derivative securities
No Table II lines on this filing.
Explanation of responses
- F1These securities are owned by The Tile Shop, Inc. ("TS, Inc."). The reporting person is the sole officer and member of the board of directors of TS, Inc., holds sole voting and dispositive power over the securities held by TS, Inc., and may be deemed to beneficially own the securities held by TS, Inc..