Sec Form 3 Filing - JACKSON SAM @ DOMINOS PIZZA INC - 2023-11-06

Insider filing report for Changes in Beneficial Ownership
"Insiders might sell their shares for any number of reasons, but they buy them for only one: they think the price will rise"
- Peter Lynch
What is insider trading>>
FORM 3
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
Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(h) of the Investment Company Act of 1940
OMB APPROVAL
OMB Number: 3235-0287
Expires: November 30, 2011
Estimated average burden hours per response... 0.5
1. Name and Address of Reporting Person
JACKSON SAM
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, Human Resources
(Last) (First) (Middle)
30 FRANK LLOYD WRIGHT DR
3. Date of Earliest Transaction (MM/DD/YY)
11/06/2023
(Street)
ANN ARBOR, MI48105
4. If Amendment, Date Original Filed (MM/DD/YY)
6. Individual or Joint/Group Filing (Check Applicable Line)
__ X __ Form filed by One Reporting Person
_____ Form filed by More than One Reporting Person
(City) (State) (Zip)
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
1.Title of Security
(Instr. 3)
2. Transaction Date (MM/DD/YY) 2A. Deemed Execution Date, if any (MM/DD/YY) 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 2,500 ( 1 ) ( 2 ) ( 3 ) ( 4 ) ( 5 ) ( 6 ) ( 7 ) D
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 (MM/DD/YY) 3A. Deemed Execution Date, if any (MM/DD/YY) 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
(MM/DD/YY)
7. Title and Amount of Underlying Securities
(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 $ 283.68 07/18/2022 07/18/2028 Common Stock, $0.01 par value 520 D
Option to Purchase Common Stock $ 275.35 07/10/2023 07/10/2029 Common Stock, $0.01 par value 590 D
Option to Purchase Common Stock $ 413.68 07/15/2024( 8 ) 07/15/2030 Common Stock, $0.01 par value 380 D
Option to Purchase Common Stock $ 413.68 07/15/2024( 8 ) 07/15/2030 Common Stock, $0.01 par value 120 D
Option to Purchase Common Stock $ 367.79 03/31/2024( 9 ) 03/31/2031 Common Stock, $0.01 par value 450 D
Option to Purchase Common Stock $ 393.14 03/10/2025( 10 ) 03/10/2032 Common Stock, $0.01 par value 429 D
Option to Purchase Common Stock $ 300.16 03/10/2026( 11 ) 03/10/2033 Common Stock, $0.01 par value 530 D
Reporting Owners
Reporting Owner Name / Address Relationships
Director 10% Owner Officer Other
JACKSON SAM
30 FRANK LLOYD WRIGHT DR
ANN ARBOR, MI48105
EVP, Human Resources
Signatures
/s/ Kevin S. Morris, attorney-in-fact 11/08/2023
Signature of Reporting Person Date
Explanation of Responses:
( 1 )Includes 75 shares of common stock representing the final tranche of an original grant of performance-based restricted stock that shall vest on July 15, 2024 if applicable performance conditions are achieved.
( 2 )Includes 25 shares of common stock representing the final tranche of an original grant of performance-based restricted stock that shall vest on July 15, 2024 if applicable performance conditions are achieved.
( 3 )Includes 115 shares of common stock representing the final tranche of an original restricted stock unit award with service-based vesting criteria that shall vest on March 31, 2024. Shares are issued and delivered following each vesting tranche of the award.
( 4 )Includes 147 shares of common stock representing the final tranche of an original restricted stock unit award with service-based vesting criteria that shall vest on July 19, 2024. Shares are issued and delivered following each vesting tranche of the award.
( 5 )Includes 1,578 shares of common stock representing an original restricted stock unit award with service-based vesting criteria that shall vest one-fourth on March 10, 2024, one-fourth on March 10, 2025 and one-half on March 10, 2026. Shares are issued and delivered following each vesting tranche of the award.
( 6 )Includes 237 shares of common stock representing the final two tranches of an original restricted stock unit award with service-based vesting criteria that shall vest one-half on each of March 10, 2024 and March 10, 2025. Shares are issued and delivered following each vesting tranche of the award.
( 7 )Includes 323 shares of common stock representing an original restricted stock unit award with service-based vesting criteria that shall vest one-third on each of March 10, 2024, March 10, 2025 and March 10, 2026. Shares are issued and delivered following each vesting tranche of the award.
( 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 each of July 15, 2021, July 15, 2022 and July 15, 2023 and one-fourth shall vest on July 15, 2024.
( 9 )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 March 31, 2022 and March 31, 2023 and one-third shall vest on March 31, 2024.
( 10 )The options to purchase common stock vest one-third each year on the anniversary date of the grant date. Thus, one-third vested on March 10, 2023 and one-third shall vest on each of March 10, 2024 and March 10, 2025.
( 11 )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 10, 2024, March 10, 2025 and March 10, 2026.

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).

Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure.
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number.