Initial Statement of Beneficial Ownership (3)
August 28 2020 - 4:53PM
Edgar (US Regulatory)
FORM 3
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES
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OMB APPROVAL
OMB Number:
3235-0104
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Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 or Section 30(h) of the Investment Company Act of 1940
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1. Name and Address of Reporting Person
*
HEADEN CYNTHIA A |
2. Date of Event Requiring Statement (MM/DD/YYYY)
8/20/2020
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3. Issuer Name and Ticker or Trading Symbol
DOMINOS PIZZA INC [DPZ]
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(Last)
(First)
(Middle)
30 FRANK LLOYD WRIGHT DR |
4. Relationship of Reporting Person(s) to Issuer (Check all applicable)
_____ Director _____ 10% Owner ___X___ Officer (give title below) _____ Other (specify below) EVP, Supply Chain Services / |
(Street)
ANN ARBOR, MI 48105
(City)
(State)
(Zip)
| 5. If Amendment, Date Original Filed(MM/DD/YYYY)
| 6. Individual or Joint/Group Filing(Check Applicable Line)
_X_ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person
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Table I - Non-Derivative Securities Beneficially Owned
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1.Title of Security (Instr. 4) | 2. Amount of Securities Beneficially Owned (Instr. 4) | 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) | 4. Nature of Indirect Beneficial Ownership (Instr. 5) |
Common Stock, $0.01 par value | 2522.342 (1)(2)(3)(4)(5)(6)(7) | D | |
Common Stock, $0.01 par value | 22.368 | I | Owned by spouse |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security (Instr. 4) | 2. Date Exercisable and Expiration Date (MM/DD/YYYY) | 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) |
Date Exercisable | Expiration Date | Title | Amount or Number of Shares |
Option to Purchase Common Stock | 7/19/2021 (8) | 7/19/2027 | Common Stock, $0.01 par value | 515 | $212.52 | D | |
Option to Purchase Common Stock | 7/18/2022 (9) | 7/18/2028 | Common Stock, $0.01 par value | 900 | $283.68 | D | |
Option to Purchase Common Stock | 7/10/2023 (10) | 7/10/2029 | Common Stock, $0.01 par value | 520 | $275.35 | D | |
Option to Purchase Common Stock | 7/15/2024 (11) | 7/15/2030 | Common Stock, $0.01 par value | 580 | $413.68 | D | |
Option to Purchase Common Stock | 7/15/2024 (11) | 7/15/2030 | Common Stock, $0.01 par value | 180 | $413.68 | D | |
Option to Purchase Common Stock | 8/20/2024 (12) | 8/20/2030 | Common Stock, $0.01 par value | 500 | $418.33 | D | |
Explanation of Responses: |
(1) | Includes 145 shares of common stock representing the final tranche of an original grant of performance-based restricted stock that shall vest on July 19, 2021 if applicable performance conditions are achieved. |
(2) | Includes 230 shares of common stock representing the final two tranches of an original grant of performance-based restricted stock that shall vest one-half on each of July 18, 2021 and July 18, 2022 if applicable performance conditions are achieved. |
(3) | Includes 630 shares of common stock representing the final three tranches of an original grant of performance-based restricted stock that shall vest one-third on each of February 20, 2021, February 20, 2022 and February 20, 2023 if applicable performance conditions are achieved. |
(4) | Includes 278 shares of common stock representing the final three tranches of an original grant of performance-based restricted stock that shall vest one-third on each of July 10, 2021, July 10, 2022 and July 10, 2023 if applicable performance conditions are achieved. |
(5) | Includes 140 shares of common stock representing an original grant of performance-based restricted stock that shall vest one-fourth on each of July 15, 2021, July 15, 2022, July 15, 2023 and July 15, 2024 if applicable performance conditions are achieved. |
(6) | Includes 450 shares of common stock representing an original grant of performance-based restricted stock that shall vest one-fourth on each of July 15, 2021, July 15, 2022, July 15, 2023 and July 15, 2024 if applicable performance conditions are achieved. |
(7) | Includes 130 shares of common stock representing an original grant of performance-based restricted stock that shall vest one-fourth on each of August 20, 2021, August 20, 2022, August 20, 2023 and August 20, 2024 if applicable performance conditions are achieved. |
(8) | The number of underlying shares represents the unexercised portion of the original grant as of the date of this report. One-half of the unexercised options vested on July 19, 2020 and one-half shall vest on July 19, 2021. |
(9) | The options to purchase common stock vest one-fourth each year on the anniversary date of the grant date. Thus, one-fourth vested on each of July 18, 2019 and July 18, 2020 and one-fourth shall vest on each of July 18, 2021 and July 18, 2022. |
(10) | The options to purchase common stock vest one-fourth each year on the anniversary date of the grant date. Thus, one-fourth vested on July 10, 2020 and one-fourth shall vest on each of July 10, 2021, July 10, 2022 and July 10, 2023. |
(11) | The options to purchase common stock vest one-fourth each year on the anniversary date of the grant date. Thus, one-fourth shall vest on each of July 15, 2021, July 15, 2022, July 15, 2023 and July 15, 2024. |
(12) | The options to purchase common stock vest one-fourth each year on the anniversary date of the grant date. Thus, one-fourth shall vest on each of August 20, 2021, August 20, 2022, August 20, 2023 and August 20, 2024. |
Reporting Owners
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Reporting Owner Name / Address | Relationships |
Director | 10% Owner | Officer | Other |
HEADEN CYNTHIA A 30 FRANK LLOYD WRIGHT DR ANN ARBOR, MI 48105 |
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| EVP, Supply Chain Services |
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Signatures
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/s/ Kevin S. Morris, attorney-in-fact | | 8/28/2020 |
**Signature of Reporting Person | Date |
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