0001195734-15-000005.txt : 20150512 0001195734-15-000005.hdr.sgml : 20150512 20150512150403 ACCESSION NUMBER: 0001195734-15-000005 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20150508 FILED AS OF DATE: 20150512 DATE AS OF CHANGE: 20150512 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: 1231 BUSINESS ADDRESS: STREET 1: 222 MERCHANDISE MART PLAZA STREET 2: 23RD FLOOR CITY: CHICAGO STATE: IL ZIP: 60654 BUSINESS PHONE: 3129510600 MAIL ADDRESS: STREET 1: 222 MERCHANDISE MART PLAZA STREET 2: 23RD FLOOR CITY: CHICAGO STATE: IL ZIP: 60654 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Avedisian Vann A CENTRAL INDEX KEY: 0001587652 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-36104 FILM NUMBER: 15854097 MAIL ADDRESS: STREET 1: C/O POTBELLY CORPORATION STREET 2: 222 MERCHANDISE MART PLAZA, 23RD FLOOR CITY: CHICAGO STATE: IL ZIP: 60654 4 1 edgardoc.xml PRIMARY DOCUMENT X0306 4 2015-05-08 0 0001195734 POTBELLY CORP PBPB 0001587652 Avedisian Vann A 222 MERCHANDISE MART PLAZA 23RD FLOOR CHICAGO IL 60654 1 0 1 0 Common Stock 2015-05-08 4 J 0 25813.0 0.0 D 778003 I See Footnote Common Stock 2015-05-08 4 J 0 864.0 0.0 A 4320 I by AGA Trust Common Stock 2015-05-08 4 J 0 9286.0 0.0 A 233218 I by VAA Trust Common Stock 2558 D Common Stock 464 I by Daughter Common Stock 464 I by Son On May 8, 2015, Concorde Holdings IX, LLC ("Concorde") distributed 25,813 of the shares held by its members without the payment of any consideration, including to various trusts controlled by the reporting person as reflected on this Form 4. Includes 700,569 shares held by Oxford Blackpoint Venture Partners VII, LLC ("Oxford Blackpoint") and 77,434 shares held by Concorde. Oxford Blackpoint is an investment fund managed by Oxford Capital Partners, Inc. ("Oxford Capital"). Mr. Avedisian is co-owner of Oxford Capital and co-owner of Concorde. Accordingly, Mr. Avedisian may be deemed to share power to vote and dispose of shares owned directly by such entities. Mr. Avedisian disclaims beneficial ownership of such shares except to the extent of his pecuniary interest therein. Mr. Avedisian is the trusteee of the Armen G. Avedisian Trust ( the "AGA Trust"). Accordingly, Mr. Avedisian may be deemed to have the power to vote and dispose of shares owned directly by the AGA Trust. Mr. Avedisian disclaims beneficial ownership of such shares except to the extent of his pecuniary interest therein. By: Robyn Martin For: Vann Avedisian 2015-05-12