0000899243-21-017299.txt : 20210428 0000899243-21-017299.hdr.sgml : 20210428 20210428213925 ACCESSION NUMBER: 0000899243-21-017299 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20210426 FILED AS OF DATE: 20210428 DATE AS OF CHANGE: 20210428 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Dixon Adiya CENTRAL INDEX KEY: 0001838731 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-36104 FILM NUMBER: 21866745 MAIL ADDRESS: STREET 1: 111 N CANAL STREET 2: SUITE 850 CITY: CHICAGO STATE: IL ZIP: 60606 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: POTBELLY CORP CENTRAL INDEX KEY: 0001195734 STANDARD INDUSTRIAL CLASSIFICATION: RETAIL-EATING PLACES [5812] IRS NUMBER: 364466837 FISCAL YEAR END: 1230 BUSINESS ADDRESS: STREET 1: 111 N. CANAL STREET 2: SUITE 325 CITY: CHICAGO STATE: IL ZIP: 60606 BUSINESS PHONE: 3129510600 MAIL ADDRESS: STREET 1: 111 N. CANAL STREET 2: SUITE 325 CITY: CHICAGO STATE: IL ZIP: 60606 4 1 doc4.xml FORM 4 SUBMISSION X0306 4 2021-04-26 0 0001195734 POTBELLY CORP PBPB 0001838731 Dixon Adiya 111 N. CANAL SUITE 325 CHICAGO IL 60606 0 1 0 0 SVP, CLO and Secretary Common Stock 2021-04-26 4 A 0 25210 0.00 A 25210 D Performance Stock Units 2021-04-26 4 A 0 25210 0.00 A Common Stock 25210 25210 D Represents an award of restricted stock units. Each restricted stock unit represents a contingent right to receive one share of the Issuer's common stock. These restricted stock units vest in equal installments on April 26, 2022, April 26, 2023 and April 26, 2024. Represents an award of performance stock units which vest based on performance versus certain metrics as described in the award agreement. /s/ Adiya Dixon 2021-04-28