SEC FORM 3 SEC Form 3
FORM 3 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES

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*
BRAKEMAN ROY EDGAR III

(Last) (First) (Middle)
C/O BROOKSIDE CAPITAL MANAGEMENT , LLC
111 HUNTINGTON AVENUE

(Street)
BOSTON MA 02199

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
07/13/2004
3. Issuer Name and Ticker or Trading Symbol
DOMINOS PIZZA INC [ DPZ ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director X 10% Owner
Officer (give title below) Other (specify below)
5. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
Form filed by One Reporting Person
X Form filed by More than One Reporting Person
Table I - Non-Derivative Securities Beneficially Owned
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, $.01 par value 2,596,046 I See footnote(1)
Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
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: 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
1. Name and Address of Reporting Person*
BRAKEMAN ROY EDGAR III

(Last) (First) (Middle)
C/O BROOKSIDE CAPITAL MANAGEMENT , LLC
111 HUNTINGTON AVENUE

(Street)
BOSTON MA 02199

(City) (State) (Zip)
1. Name and Address of Reporting Person*
BROOKSIDE CAPITAL PARTNERS FUND LP

(Last) (First) (Middle)
C/O BAIN CAPITAL INVESTORS, LLC
111 HUNTINGTON AVENUE

(Street)
BOSTON MA 02199

(City) (State) (Zip)
1. Name and Address of Reporting Person*
BROOKSIDE CAPITAL INVESTORS L P

(Last) (First) (Middle)
C/O BAIN CAPITAL INVESTORS, LLC
111 HUNTINGTON AVENUE

(Street)
BOSTON MA 02199

(City) (State) (Zip)
1. Name and Address of Reporting Person*
BROOKSIDE CAPITAL MANAGEMENT LLC

(Last) (First) (Middle)
C/O BAIN CAPITAL INVESTORS, LLC
111 HUNTINGTON AVENUE

(Street)
BOSTON MA 02199

(City) (State) (Zip)
Explanation of Responses:
1. Roy Edgar Brakeman, III, as the sole managing member of Brookside Capital Management, LLC ("BCM"), BCM, as the sole general partner of Brookside Capital Investors, L.P. ("BCI"), and BCI, as the sole general partner of Brookside Capital Partners Fund, L.P. ("BCP"), may each be deemed to share voting and dispositive power with respect to the shares held by BCP. Mr. Brakeman, BCM and BCI disclaim beneficial ownership of such securities except to the extent of their pecuniary interest therein.
Brookside Capital Management, LLC, for itself, on behalf of itself in its capacity as sole general partner of Brookside Capital Investors, L.P. 07/13/2004
and on behalf of Brookside Capital Investors, L.P. in its capacity as sole general partner of Brookside Capital Partners Fund, L.P. 07/13/2004
by: /s/ Roy Edgar Brakeman III 07/13/2004
** Signature of Reporting Person Date
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
* 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).
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