SEC FORM 4 SEC Form 4
FORM 4 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP

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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Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
1. Name and Address of Reporting Person*
HEADEN CYNTHIA A

(Last) (First) (Middle)
30 FRANK LLOYD WRIGHT DRIVE

(Street)
ANN ARBOR MI 48105

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
DOMINOS PIZZA INC [ DPZ ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director 10% Owner
X Officer (give title below) Other (specify below)
EVP, Chief Supply Chain Offr
3. Date of Earliest Transaction (Month/Day/Year)
03/11/2024
4. 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
Rule 10b5-1(c) Transaction Indication

  
Check this box to indicate that a transaction was made pursuant to a contract, instruction or written plan that is intended to satisfy the affirmative defense conditions of Rule 10b5-1(c). See Instruction 10.
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
1. Title of Security (Instr. 3) 2. Transaction Date (Month/Day/Year) 2A. Deemed Execution Date, if any (Month/Day/Year) 3. Transaction Code (Instr. 8) 4. Securities Acquired (A) or Disposed Of (D) (Instr. 3, 4 and 5) 5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4) 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 7. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V Amount (A) or (D) Price
Common Stock, $0.01 par value 03/11/2024 A(1) 751 A $0 5,240.111(2) D
Common Stock, $0.01 par value 03/12/2024 F 110 D $443.9 5,130.111 D
Common Stock, $0.01 par value 03/12/2024 F 259 D $443.9 4,871.111 D
Common Stock, $0.01 par value 22.368 I Owned by spouse
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 3) 2. Conversion or Exercise Price of Derivative Security 3. Transaction Date (Month/Day/Year) 3A. Deemed Execution Date, if any (Month/Day/Year) 4. Transaction 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 (Month/Day/Year) 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: 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 $443.9 03/11/2024 A(3) 2,384 03/11/2027 03/11/2034 Common Stock, $0.01 par value 2,384 $0 2,384 D
Explanation of Responses:
1. Represents a restricted stock unit award with service-based vesting criteria that shall vest one-third each year on the anniversary date of the grant date. Thus, one-third shall vest on each of March 11, 2025, March 11, 2026 and March 11, 2027. Shares are issued and delivered following each vesting tranche of the award.
2. Includes 60.512 shares acquired under the Domino's Employee Stock Payroll Deduction Plan since the date of the last report.
3. The options to purchase common stock vest one-third each year on the anniversary date of the grant date. Thus, one-third shall vest on each of March 11, 2025, March 11, 2026 and March 11, 2027.
/s/ Kevin S. Morris, attorney-in-fact 03/13/2024
** 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 4 (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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