0001195734-22-000026.txt : 20220407 0001195734-22-000026.hdr.sgml : 20220407 20220407182939 ACCESSION NUMBER: 0001195734-22-000026 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20220401 FILED AS OF DATE: 20220407 DATE AS OF CHANGE: 20220407 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Douglas Jeffrey CENTRAL INDEX KEY: 0001789923 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-36104 FILM NUMBER: 22814949 MAIL ADDRESS: STREET 1: 111 N. CANAL STREET, 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 wf-form4_164937056668359.xml FORM 4 X0306 4 2022-04-01 0 0001195734 POTBELLY CORP PBPB 0001789923 Douglas Jeffrey 111 N. CANAL SUITE 325 CHICAGO IL 60606 0 1 0 0 SVP, Chief Information Officer Common Stock 2022-04-01 4 A 0 19055 0 A 149471 D Performance Stock Units 2022-04-01 4 A 0 19054 0 A Common Stock 19054.0 19054 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 1, 2023, April 1, 2024 and April 1, 2025. Represents an award of performance stock units which vest based on performance versus certain metrics as described in the award agreement. /s/ Jeffrey Douglas 2022-04-07