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