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