UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(h) of the Investment Company Act of 1940 |
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | SEC 1473 (7-02) | ||
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB control number. |
1. Title of Derivative Security (Instr. 4) |
2. Date Exercisable and Expiration Date (Month/Day/Year) |
3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) |
4. Conversion or Exercise Price of Derivative Security | 5. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 5) |
6. Nature of Indirect Beneficial Ownership (Instr. 5) |
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Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||
Stock Options (right to buy) | Â (1) | 10/19/2018 | Common Stock | 20,000 | $ 8 | D | Â |
Stock Options (right to buy) | Â (1) | 05/10/2021 | Common Stock | 19,169 | $ 7.22 | D | Â |
Stock Options (right to buy) | Â (2) | 04/09/2023 | Common Stock | 17,983 | $ 9.47 | D | Â |
Stock Options (right to buy) | Â (3) | 04/09/2023 | Common Stock | 14,462 | $ 9.47 | D | Â |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
GOTTSCHALK MARLA C C/O POTBELLY CORPORATION 222 MERCHANDISE MART PLAZA, 23RD FLOOR CHICAGO, IL 60654 |
 X |  |  |  |
/s/Matthew J. Revord, Attorney-in-fact | 10/03/2013 | |
**Signature of Reporting Person | Date |
* | If the form is filed by more than one reporting person, see Instruction 5(b)(v). |
** | Intentional misstatements or omissions of facts constitute Federal Criminal Violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). |
(1) | All stock options have vested and become exercisable upon the closing of the initial public offering of Potbelly Corporation ("Potbelly"). |
(2) | The stock options became vested as to 8,992 shares on April 9, 2013 and become vested as to the remaining 8,991 shares on April 9, 2014. Vested options become exercisable upon the closing of Potbelly's initial public offering. |
(3) | The stock options will vest in equal installments on April 9, 2014 and April 9, 2015. Vested options will become exercisable upon the closing of Potbelly's initial public offering. |