SEC Form 4 · accession 0001195734-16-000068
POTBELLY CORP · PBPB
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Nancy F Turk
Officer — SVP HR & Corp. Comm.
Period of report
Mar 4, 2016
Accepted (ET)
Mar 8, 2016 · 5:17 pm EST
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0001195734
Table I — non-derivative securities
No Table I lines on this filing.
Table II — derivative securities
| Security | Conv. / exercise price | Date | Code | Shares | A/D | Exercisable | Expires | Underlying | Underlying shares | Owned after | D/I |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Non-Qualified Stock Option (right to buy)F3,F2 | $13.73 | Mar 4, 2016 | A | 21,109 | A | — | Mar 4, 2026 | Common Stock | 21,109 | 21,109 | D |
Explanation of responses
- F1Option award pursuant to the Potbelly Corporation 2013 Long-Term Incentive Plan.
- F2The option vests in four equal annual installments beginning on the first anniversary of the Transaction Date.
- F3Since the date of the reporting person's last ownership report, she transferred 15,582 shares of Potbelly Corporation common stock and an employee stock option to purchase 72,804 shares of Potbelly Corporation common stock pursuant to a domestic relations order. The reporting person no longer reports as beneficially owned any of these transferred securities.