0001195734-16-000080.txt : 20160516 0001195734-16-000080.hdr.sgml : 20160516 20160516145550 ACCESSION NUMBER: 0001195734-16-000080 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20160512 FILED AS OF DATE: 20160516 DATE AS OF CHANGE: 20160516 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: 111 N. CANAL STREET 2: SUITE 850 CITY: CHICAGO STATE: IL ZIP: 60606 BUSINESS PHONE: 3129510600 MAIL ADDRESS: STREET 1: 111 N. CANAL STREET 2: SUITE 850 CITY: CHICAGO STATE: IL ZIP: 60606 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: LEWIS AYLWIN B CENTRAL INDEX KEY: 0001211695 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-36104 FILM NUMBER: 161652959 MAIL ADDRESS: STREET 1: 111 N. CANAL STREET 2: SUITE 850 CITY: CHICAGO STATE: IL ZIP: 60606 4 1 edgardoc.xml PRIMARY DOCUMENT X0306 4 2016-05-12 0 0001195734 POTBELLY CORP PBPB 0001211695 LEWIS AYLWIN B 111 N. CANAL SUITE 850 CHICAGO IL 60606 1 1 0 0 CEO & President Non-Qualified Stock Option (right to buy) 13.27 2016-05-12 4 A 0 50000.0 0.0 A 2026-05-12 Common Stock 50000 50000 D Option award pursuant to the Potbelly Corporation 2013 Long-Term Incentive Plan. The option vests in four equal annual installments beginning on the first anniversary of the Transaction Date. By: Robyn Martin For: Aylwin Lewis 2016-05-16