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*
CURTIS THOMAS BENJAMIN

(Last) (First) (Middle)
DOMINO'S PIZZA
3

(Street)
ANN ARBOR MI 48105

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
02/19/2020
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)
EVP, U.S. Operations & Support
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 11,325(1)(2)(3)(4) D
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)
Date Exercisable Expiration Date Title Amount or Number of Shares
Option to Purchase Common Stock 07/16/2018 07/16/2024 Common Stock, $0.01 par value 378 $73.04 D
Option to Purchase Common Stock 07/15/2019 07/15/2025 Common Stock, $0.01 par value 625 $118.54 D
Option to Purchase Common Stock 07/20/2020(5) 07/20/2026 Common Stock, $0.01 par value 1,073 $136.89 D
Option to Purchase Common Stock 07/19/2021(6) 07/19/2027 Common Stock, $0.01 par value 1,230 $212.52 D
Option to Purchase Common Stock 07/18/2022(7) 07/18/2028 Common Stock, $0.01 par value 2,420 $283.68 D
Option to Purchase Common Stock 07/10/2023(8) 07/10/2029 Common Stock, $0.01 par value 3,060 $275.35 D
Explanation of Responses:
1. Includes 169 shares of common stock representing the final tranche of an original grant of performance-based restricted stock that shall vest on July 20, 2020 if applicable performance conditions are achieved.
2. Includes 296 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 19, 2020 and July 19, 2021 if applicable performance conditions are achieved.
3. Includes 465 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 18, 2020, July 18, 2021 and July 18, 2022 if applicable performance conditions are achieved.
4. Includes 730 shares of common stock representing a grant of performance-based restricted stock that shall vest one-fourth on each of July 10, 2020, July 10, 2021, July 10, 2022 and July 10, 2023 if applicable performance conditions are achieved.
5. 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 20, 2017, July 20, 2018 and July 20, 2019 and one-fourth shall vest on July 20, 2020.
6. 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 19, 2018 and July 19, 2019 and one-fourth shall vest on each of July 19, 2020 and July 19, 2021.
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 July 18, 2019 and one-fourth shall vest on each of July 18, 2020, July 18, 2021 and July 18, 2022.
8. 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 10, 2020, July 10, 2021, July 10, 2022 and July 10, 2023.
Remarks:
/s/ Kevin S. Morris, attorney-in-fact 02/28/2020
** 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).
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure.
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