SEC Filing - Domino's Pizza

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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^*

ALLISON RICHARD E JR

(Last)

(First)

(Middle)

DOMINO'S PIZZA

30 FRANK LLOYD WRIGHT DRIVE

(Street)

ANN ARBOR

48105

(City)

(State)

(Zip)

2. Date of Event Requiring Statement (Month/Day/Year)
10/14/2014

3. Issuer Name and Ticker or Trading Symbol
DOMINOS PIZZA INC [ DPZ ]

4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)

	Director	10% Owner
X	Officer (give title below)	Other (specify below)
President, Domino's Int'l

5. If Amendment, Date of Original Filed (Month/Day/Year)

6. Individual or Joint/Group Filing (Check Applicable Line)

X	Form filed by One Reporting Person
	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, $0.01 par value	216,676.474⁽¹⁾⁽²⁾⁽³⁾⁽⁴⁾⁽⁵⁾	D
Common Stock, $0.01 par value	100	I	Held by Son

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)
1. Title of Derivative Security (Instr. 4)	Date Exercisable	Expiration Date	Title	Amount or Number of Shares	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)
Option to Purchase Common Stock	03/14/2014	03/14/2021	Common Stock, $0.01 par value	66,667	14.53	D
Option to Purchase Common Stock	03/14/2012	03/14/2021	Common Stock, $0.01 par value	33,333	17.53	D
Option to Purchase Common Stock	07/20/2014	07/20/2021	Common Stock, $0.01 par value	3,334	22.78	D
Option to Purchase Common Stock	07/20/2012	07/20/2021	Common Stock, $0.01 par value	1,666	25.78	D
Option to Purchase Common Stock	07/20/2015⁽⁶⁾	07/20/2022	Common Stock, $0.01 par value	9,690	32.69	D
Option to Purchase Common Stock	02/27/2017⁽⁷⁾	02/27/2023	Common Stock, $0.01 par value	19,670	46.83	D
Option to Purchase Common Stock	07/17/2017⁽⁸⁾	07/17/2023	Common Stock, $0.01 par value	14,480	63.05	D
Option to Purchase Common Stock	07/16/2018⁽⁹⁾	07/16/2024	Common Stock, $0.01 par value	15,110	73.04	D

Explanation of Responses:

1. Includes 3,827 shares of common stock representing one-third of an original grant of performance-based restricted stock that shall vest on July 20, 2015 if applicable performance conditions are achieved.

2. Includes 3,278 shares of common stock representing three-fourths of an original grant of performance-based restricted stock that shall vest one-third on each of July 17, 2015, July 17, 2016 and July 17, 2017 if applicable performance conditions are achieved.

3. Includes 6,220 shares of common stock representing three-fourths of an original grant of performance-based restricted stock that shall vest one-third on each of February 27, 2015, February 27, 2016 and February 27, 2017 if applicable performance conditions are achieved.

4. Includes 4,350 shares of common stock representing a grant of performance-based restricted stock that shall vest one-fourth on each of July 16, 2015, July 16, 2016, July 16, 2017 and July 16, 2018 if applicable performance conditions are achieved.

5. Includes 912.474 shares held in Domino's Employee Stock Payroll Deduction Plan.

6. The options to purchase common stock vest one-third each year on the anniversary date of the grant date. Thus, one-third vested on each of July 20, 2013 and July 20, 2014, and one-third shall vest on July 20, 2015.

7. The options to purchase common stock vest one-fourth each year on the anniversary date of the grant date. Thus, one-fourth vested on February 27, 2014, and one-fourth shall vest on each of February 27, 2015, February 27, 2016 and February 27, 2017.

8. 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 17, 2014, and one-fourth shall vest on each of July 17, 2015, July 17, 2016 and July 17, 2017.

9. 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 16, 2015, July 16, 2016, July 16, 2017 and July 16, 2018.

	/s/ Adam J. Gacek, attorney-in-fact	10/16/2014
	** 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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