Form Type: 4

SEC EDGAR Link
Accession Number:0001104659-20-085639
Date:2020-07-21
Issuer: TILE SHOP HOLDINGS, INC. (TTSH)
Original Submission Date:

Reporting Person:

KAMIN PETER
C/O TILE SHOP HOLDINGS, INC.
14000 CARLSON PARKWAY PLYMOUTH, MN 55441

Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
Title of SecurityTransaction Date2a. Deemed Execution Date Transaction CodeSharesAcquired or DisposedPrice per share 5. Amount of Securities Beneficially Owned Following Reported Transaction 6. Ownership Form Direct or IndirectNature of Indirect Ownership
COMMON STOCK 2020-07-21 A 107,849 a $0.00 3,361,243 direct
COMMON STOCK 2020-07-21 0 $0.00 1,694,608 indirect f2
COMMON STOCK 2020-07-21 0 $0.00 1,033,562 indirect f3
COMMON STOCK 2020-07-21 0 $0.00 333,307 indirect f4
COMMON STOCK 2020-07-21 0 $0.00 97,453 indirect f5
COMMON STOCK 2020-07-21 0 $0.00 328,711 indirect f6
Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, convertible securities
Title of Derivative Security Conversion or Exercise Price of Derivative Security Transaction Date Deemed Execution Date Transaction Code Number of Derivative Securities Acquired (A) or Disposed of (D) Date ExercisableExpiration Date Title and Amount of Securities Underlying Derivative Security Price of Derivative Security Number of derivative Securities Beneficially Owned Following Reported Transaction(s) Ownership Form: Direct (D) or Indirect (I) Nature of Indirect Beneficial Ownership
Footnotes
IDfootnote
f1 represents 107,849 shares of restricted stock granted pursuant to the company's 2012 omnibus award plan, which are subject to a risk of forfeiture until the earlier of (a) the date of the company's next annual meeting of stockholders and (b) july 21, 2021.
f2 these securities are owned by the peter h. kamin revocable trust dated february 2003. the reporting person is trustee of the trust. 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.
f3 these securities are owned by the peter h. kamin childrens trust dated march 1997. the reporting person is trustee of the trust. 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.
f4 these securities are owned by the 3k limited partnership. the reporting person is general partner of the limited partnership. 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.
f5 these securities are owned by the peter h. kamin family foundation. the reporting person is trustee of the foundation. 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.
f6 these securities are owned by the peter h. kamin gst trust. the reporting person is trustee of the trust. 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.
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