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*
GARRIDO FRANK

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

(Street)
ANN ARBOR MI 48105

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
03/15/2021
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 2,190.887(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 07/19/2021(5) 07/19/2027 Common Stock, $0.01 par value 470 212.52 D
Option to Purchase Common Stock 07/18/2022(6) 07/18/2028 Common Stock, $0.01 par value 950 283.68 D
Option to Purchase Common Stock 07/10/2023(7) 07/10/2029 Common Stock, $0.01 par value 820 275.35 D
Option to Purchase Common Stock 07/15/2024(8) 07/15/2030 Common Stock, $0.01 par value 610 413.68 D
Explanation of Responses:
1. Includes 144 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 246 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 435 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.
4. Includes 470 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.
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 19, 2018, July 19, 2019 and July 19, 2020 and one-fourth shall vest on July 19, 2021.
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 18, 2019 and July 18, 2020 and one-fourth shall vest on each of July 18, 2021 and July 18, 2022.
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 10, 2020 and one-fourth shall vest on each of July 10, 2021, July 10, 2022 and July 10, 2023.
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 15, 2021, July 15, 2022, July 15, 2023 and July 15, 2024.
Remarks:
/s/ Kevin S. Morris, attorney-in-fact 03/23/2021
** 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.
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.