Sec Form 4 Filing - ALLISON RICHARD E JR @ DOMINOS PIZZA INC - 2019-05-16

Insider filing report for Changes in Beneficial Ownership
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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
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
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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 [ DPZ]
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/YY)
05/16/2019
(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 05/16/2019 M 3,333 A $ 17.53 43,059.843 ( 1 ) D
Common Stock, $0.01 par value 05/16/2019 S 3,333 D $ 279.46 ( 2 ) 39,726.843 D
Common Stock, $0.01 par value 05/16/2019 M 6,667 A $ 14.53 46,393.843 D
Common Stock, $0.01 par value 05/16/2019 S 6,667 D $ 279.05 ( 3 ) 39,726.843 D
Common Stock, $0.01 par value 250 I Son
Common Stock, $0.01 par value 250 I Daughter
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 $ 17.53 05/16/2019 M 3,333 03/14/2014 03/14/2021 Common Stock, $0.01 par value 3,333 $ 0 30,000 D
Option to Purchase Common Stock $ 14.53 05/16/2019 M 6,667 03/14/2014 03/14/2021 Common Stock, $0.01 par value 6,667 $ 0 0 D
Reporting Owners
Reporting Owner Name / Address Relationships
Director 10% Owner Officer Other
ALLISON RICHARD E JR
DOMINO'S PIZZA
30 FRANK LLOYD WRIGHT DRIVE
ANN ARBOR, MI48105
X Chief Executive Officer
Signatures
/s/ Kevin S. Morris, attorney-in-fact 05/20/2019
Signature of Reporting Person Date
Explanation of Responses:
( 1 )Includes 236.486 shares acquired under the Domino's Employee Stock Payroll Deduction Plan.
( 2 )This transaction was executed in multiple trades at prices ranging from $279.26 to $279.76. The price reported above reflects the weighted average sale price.
( 3 )This transaction was executed in multiple trades at prices ranging from $279.05 to $279.09. The price reported above reflects the weighted average sale price.

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* If the form is filed by more than one reporting person, see Instruction 4(b)(v).
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