UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(h) of the Investment Company Act of 1940 |
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | SEC 1473 (7-02) | ||
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB control number. |
1. Title of Derivative Security (Instr. 4) |
2. Date Exercisable and Expiration Date (Month/Day/Year) |
3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) |
4. Conversion or Exercise Price of Derivative Security | 5. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 5) |
6. Nature of Indirect Beneficial Ownership (Instr. 5) |
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Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||
Stock Option (right to buy) | Â (2) | 10/21/2021 | Common Stock | 5,700 | $ 8.58 | D | Â |
Stock Option (right to buy) | Â (3) | 08/21/2022 | Common Stock | 2,750 | $ 10 | D | Â |
Stock Option (right to buy) | Â (4) | 07/14/2022 | Common Stock | 1,613 | $ 14.19 | D | Â |
Stock Option (right to buy) | Â (5) | 11/02/2027 | Common Stock | 26,900 | $ 8.5 | D | Â |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
Lolmaugh Cabell C/O TILE SHOP HOLDINGS, INC. 14000 CARLSON PARKWAY PLYMOUTH, MN 55441 |
 |  |  Sr. VP and COO |  |
/s/ Amanda Lorentz as Attorney-in-Fact for Cabell Lolmaugh pursuant to Power of Attorney filed herewith. | 02/26/2018 | |
**Signature of Reporting Person | Date |
* | If the form is filed by more than one reporting person, see Instruction 5(b)(v). |
** | Intentional misstatements or omissions of facts constitute Federal Criminal Violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). |
(1) | Represents 12,048 shares of restricted stock for which the risks of forfeiture will lapse in installments of 3,012 shares on each of 10/17/18, 10/17/19, 10/17/20 and 10/17/21. |
(2) | Options to purchase 2,700 shares are exercisable and options to purchase 1,500 shares vest on each of 10/21/18 and 10/21/19. |
(3) | Fully exercisable. |
(4) | Options to purchase 646 shares are exercisable, options to purchase 323 shares vest on 7/14/18 and options to purchase 322 shares vest on each of 7/14/19 and 7/14/20. |
(5) | Options to purchase 6,725 shares vest on each of 11/6/18, 11/6/19, 11/6/20 and 11/6/21. |