Sec Form 3 Filing - HEADEN CYNTHIA A @ DOMINOS PIZZA INC - 2020-08-20

Insider filing report for Changes in Beneficial Ownership
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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
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1. Name and Address of Reporting Person
HEADEN CYNTHIA A
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, Supply Chain Services
(Last) (First) (Middle)
30 FRANK LLOYD WRIGHT DR
3. Date of Earliest Transaction (MM/DD/YY)
08/20/2020
(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 2,522.342 ( 1 ) ( 2 ) ( 3 ) ( 4 ) ( 5 ) ( 6 ) ( 7 ) 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 (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 $ 212.52 07/19/2021( 8 ) 07/19/2027 Common Stock, $0.01 par value 515 D
Option to Purchase Common Stock $ 283.68 07/18/2022( 9 ) 07/18/2028 Common Stock, $0.01 par value 900 D
Option to Purchase Common Stock $ 275.35 07/10/2023( 10 ) 07/10/2029 Common Stock, $0.01 par value 520 D
Option to Purchase Common Stock $ 413.68 07/15/2024( 11 ) 07/15/2030 Common Stock, $0.01 par value 580 D
Option to Purchase Common Stock $ 413.68 07/15/2024( 11 ) 07/15/2030 Common Stock, $0.01 par value 180 D
Option to Purchase Common Stock $ 418.33 08/20/2024( 12 ) 08/20/2030 Common Stock, $0.01 par value 500 D
Reporting Owners
Reporting Owner Name / Address Relationships
Director 10% Owner Officer Other
HEADEN CYNTHIA A
30 FRANK LLOYD WRIGHT DR
ANN ARBOR, MI48105
EVP, Supply Chain Services
Signatures
/s/ Kevin S. Morris, attorney-in-fact 08/28/2020
Signature of Reporting Person Date
Explanation of Responses:
( 1 )Includes 145 shares of common stock representing the final tranche of an original grant of performance-based restricted stock that shall vest on July 19, 2021 if applicable performance conditions are achieved.
( 2 )Includes 230 shares of common stock representing the final two tranches of an original grant of performance-based restricted stock that shall vest one-half on each of July 18, 2021 and July 18, 2022 if applicable performance conditions are achieved.
( 3 )Includes 630 shares of common stock representing the final three tranches of an original grant of performance-based restricted stock that shall vest one-third on each of February 20, 2021, February 20, 2022 and February 20, 2023 if applicable performance conditions are achieved.
( 4 )Includes 278 shares of common stock representing the final three tranches of an original grant of performance-based restricted stock that shall vest one-third on each of July 10, 2021, July 10, 2022 and July 10, 2023 if applicable performance conditions are achieved.
( 5 )Includes 140 shares of common stock representing an original grant of performance-based restricted stock that shall vest one-fourth on each of July 15, 2021, July 15, 2022, July 15, 2023 and July 15, 2024 if applicable performance conditions are achieved.
( 6 )Includes 450 shares of common stock representing an original grant of performance-based restricted stock that shall vest one-fourth on each of July 15, 2021, July 15, 2022, July 15, 2023 and July 15, 2024 if applicable performance conditions are achieved.
( 7 )Includes 130 shares of common stock representing an original grant of performance-based restricted stock that shall vest one-fourth on each of August 20, 2021, August 20, 2022, August 20, 2023 and August 20, 2024 if applicable performance conditions are achieved.
( 8 )The number of underlying shares represents the unexercised portion of the original grant as of the date of this report. One-half of the unexercised options vested on July 19, 2020 and one-half shall vest on July 19, 2021.
( 9 )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 18, 2019 and July 18, 2020 and one-fourth shall vest on each of July 18, 2021 and July 18, 2022.
( 10 )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 10, 2020 and one-fourth shall vest on each of July 10, 2021, July 10, 2022 and July 10, 2023.
( 11 )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 15, 2021, July 15, 2022, July 15, 2023 and July 15, 2024.
( 12 )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 August 20, 2021, August 20, 2022, August 20, 2023 and August 20, 2024.

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