Statement of Changes in Beneficial Ownership (4)
July 28 2021 - 5:00PM
Edgar (US Regulatory)
FORM 4
[ ]
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
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OMB APPROVAL
OMB Number:
3235-0287
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0.5
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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
*
ALLISON RICHARD E JR |
2. Issuer Name and Ticker or Trading Symbol
DOMINOS PIZZA INC
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DPZ
]
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
__X__ Director _____ 10% Owner __X__ Officer (give title below) _____ Other (specify below) Chief Executive Officer |
(Last)
(First)
(Middle)
DOMINO'S PIZZA, 30 FRANK LLOYD WRIGHT DRIVE |
3. Date of Earliest Transaction
(MM/DD/YYYY)
7/26/2021 |
(Street)
ANN ARBOR, MI 48105
(City)
(State)
(Zip)
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4. If Amendment, Date Original Filed
(MM/DD/YYYY)
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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 Acquired, Disposed of, or Beneficially Owned
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1.Title of Security (Instr. 3)
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2. Trans. Date
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2A. Deemed Execution Date, if any
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3. Trans. Code (Instr. 8)
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4. Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5)
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5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4)
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6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)
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7. Nature of Indirect Beneficial Ownership (Instr. 4)
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Code
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V
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Amount
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(A) or (D)
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Price
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Common Stock, $0.01 par value | 7/26/2021 | | M | | 9690 | A | $32.69 | 53562.926 | D | |
Common Stock, $0.01 par value | 7/26/2021 | | S | | 200 | D | $523.585 (1) | 53362.926 | D | |
Common Stock, $0.01 par value | 7/26/2021 | | S | | 200 | D | $525.00 (2) | 53162.926 | D | |
Common Stock, $0.01 par value | 7/26/2021 | | S | | 200 | D | $526.095 (3) | 52962.926 | D | |
Common Stock, $0.01 par value | 7/26/2021 | | S | | 600 | D | $527.968 (4) | 52362.926 | D | |
Common Stock, $0.01 par value | 7/26/2021 | | S | | 1073 | D | $529.294 (5) | 51289.926 | D | |
Common Stock, $0.01 par value | 7/26/2021 | | S | | 1300 | D | $530.472 (6) | 49989.926 | D | |
Common Stock, $0.01 par value | 7/26/2021 | | S | | 900 | D | $531.308 (7) | 49089.926 | D | |
Common Stock, $0.01 par value | 7/26/2021 | | S | | 700 | D | $532.363 (8) | 48389.926 | D | |
Common Stock, $0.01 par value | 7/26/2021 | | S | | 1038 | D | $533.826 (9) | 47351.926 | D | |
Common Stock, $0.01 par value | 7/26/2021 | | S | | 2661 | D | $534.653 (10) | 44690.926 | D | |
Common Stock, $0.01 par value | 7/26/2021 | | S | | 518 | D | $535.613 (11) | 44172.926 | D | |
Common Stock, $0.01 par value | 7/26/2021 | | S | | 300 | D | $537.40 (12) | 43872.926 | D | |
Common Stock, $0.01 par value | 7/26/2021 | | M | | 19670 | A | $46.83 | 63542.926 | D | |
Common Stock, $0.01 par value | 7/26/2021 | | S | | 400 | D | $523.222 (13) | 63142.926 | D | |
Common Stock, $0.01 par value | 7/26/2021 | | S | | 607 | D | $524.835 (14) | 62535.926 | D | |
Common Stock, $0.01 par value | 7/26/2021 | | S | | 300 | D | $526.32 (15) | 62235.926 | D | |
Common Stock, $0.01 par value | 7/26/2021 | | S | | 900 | D | $527.964 (16) | 61335.926 | D | |
Common Stock, $0.01 par value | 7/26/2021 | | S | | 2080 | D | $529.138 (17) | 59255.926 | D | |
Common Stock, $0.01 par value | 7/26/2021 | | S | | 1800 | D | $530.184 (18) | 57455.926 | D | |
Common Stock, $0.01 par value | 7/26/2021 | | S | | 2792 | D | $531.177 (19) | 54663.926 | D | |
Common Stock, $0.01 par value | 7/26/2021 | | S | | 1257 | D | $532.311 (20) | 53406.926 | D | |
Common Stock, $0.01 par value | 7/26/2021 | | S | | 1270 | D | $533.448 (21) | 52136.926 | D | |
Common Stock, $0.01 par value | 7/26/2021 | | S | | 4982 | D | $534.396 (22) | 47154.926 | D | |
Common Stock, $0.01 par value | 7/26/2021 | | S | | 2298 | D | $535.223 (23) | 44856.926 | D | |
Common Stock, $0.01 par value | 7/26/2021 | | S | | 341 | D | $536.223 (24) | 44515.926 | D | |
Common Stock, $0.01 par value | 7/26/2021 | | S | | 643 | D | $537.428 (25) | 43872.926 | D | |
Common Stock, $0.01 par value | | | | | | | | 250 | I | Son |
Common Stock, $0.01 par value | | | | | | | | 250 | I | Daughter |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security (Instr. 3) | 2. Conversion or Exercise Price of Derivative Security | 3. Trans. Date | 3A. Deemed Execution Date, if any | 4. Trans. Code (Instr. 8) | 5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) | 6. Date Exercisable and Expiration Date | 7. Title and Amount of Securities Underlying Derivative Security (Instr. 3 and 4) | 8. Price of Derivative Security (Instr. 5) | 9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) | 10. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 4) | 11. Nature of Indirect Beneficial Ownership (Instr. 4) |
Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares |
Option to Purchase Common Stock | $32.69 | 7/26/2021 | | M | | | 9690 | 7/20/2015 | 7/20/2022 | Common Stock, $0.01 par value | 9690 | $0.00 | 0 | D | |
Option to Purchase Common Stock | $46.83 | 7/26/2021 | | M | | | 19670 | 2/27/2017 | 2/27/2023 | Common Stock, $0.01 par value | 19670 | $0.00 | 0 | D | |
Explanation of Responses: |
(1) | This transaction was executed in multiple trades at prices ranging from $523.23 to $523.94. The price reported above reflects the weighted average sale price. |
(2) | This transaction was executed in multiple trades at prices ranging from $524.98 to $525.02. The price reported above reflects the weighted average sale price. |
(3) | This transaction was executed in multiple trades at prices ranging from $526.09 to $526.10. The price reported above reflects the weighted average sale price. |
(4) | This transaction was executed in multiple trades at prices ranging from $527.46 to $528.17. The price reported above reflects the weighted average sale price. |
(5) | This transaction was executed in multiple trades at prices ranging from $528.86 to $529.77. The price reported above reflects the weighted average sale price. |
(6) | This transaction was executed in multiple trades at prices ranging from $529.94 to $530.86. The price reported above reflects the weighted average sale price. |
(7) | This transaction was executed in multiple trades at prices ranging from $530.99 to $531.91. The price reported above reflects the weighted average sale price. |
(8) | This transaction was executed in multiple trades at prices ranging from $532.01 to $532.87. The price reported above reflects the weighted average sale price. |
(9) | This transaction was executed in multiple trades at prices ranging from $533.19 to $534.16. The price reported above reflects the weighted average sale price. |
(10) | This transaction was executed in multiple trades at prices ranging from $534.20 to $535.19. The price reported above reflects the weighted average sale price. |
(11) | This transaction was executed in multiple trades at prices ranging from $535.27 to $536.12. The price reported above reflects the weighted average sale price. |
(12) | This transaction was executed in multiple trades at prices ranging from $537.25 to $537.70. The price reported above reflects the weighted average sale price. |
(13) | This transaction was executed in multiple trades at prices ranging from $522.88 to $523.69. The price reported above reflects the weighted average sale price. |
(14) | This transaction was executed in multiple trades at prices ranging from $524.31 to $525.30. The price reported above reflects the weighted average sale price. |
(15) | This transaction was executed in multiple trades at prices ranging from $526.09 to $526.44. The price reported above reflects the weighted average sale price. |
(16) | This transaction was executed in multiple trades at prices ranging from $527.46 to $528.33. The price reported above reflects the weighted average sale price. |
(17) | This transaction was executed in multiple trades at prices ranging from $528.60 to $529.57. The price reported above reflects the weighted average sale price. |
(18) | This transaction was executed in multiple trades at prices ranging from $529.74 to $530.65. The price reported above reflects the weighted average sale price. |
(19) | This transaction was executed in multiple trades at prices ranging from $530.77 to $531.72. The price reported above reflects the weighted average sale price. |
(20) | This transaction was executed in multiple trades at prices ranging from $531.82 to $532.76. The price reported above reflects the weighted average sale price. |
(21) | This transaction was executed in multiple trades at prices ranging from $532.86 to $533.85. The price reported above reflects the weighted average sale price. |
(22) | This transaction was executed in multiple trades at prices ranging from $533.86 to $534.83. The price reported above reflects the weighted average sale price. |
(23) | This transaction was executed in multiple trades at prices ranging from $534.87 to $535.81. The price reported above reflects the weighted average sale price. |
(24) | This transaction was executed in multiple trades at prices ranging from $535.89 to $536.72. The price reported above reflects the weighted average sale price. |
(25) | This transaction was executed in multiple trades at prices ranging from $536.95 to $537.86. The price reported above reflects the weighted average sale price. |
Reporting Owners
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Reporting Owner Name / Address | Relationships |
Director | 10% Owner | Officer | Other |
ALLISON RICHARD E JR DOMINO'S PIZZA 30 FRANK LLOYD WRIGHT DRIVE ANN ARBOR, MI 48105 | X |
| Chief Executive Officer |
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Signatures
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/s/ Kevin S. Morris, attorney-in-fact | | 7/28/2021 |
**Signature of Reporting Person | Date |
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