1. Name and Address of Reporting Person*
| C/O DOMINO'S PIZZA, INC., 30 FRANK LLOYD WRIGHT DRIVE | |
(Street)
| 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 |
|
3. Date of Earliest Transaction (Month/Day/Year) 06/01/2009 |
4. 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 Acquired, Disposed of, or Beneficially Owned |
1.Title of Security (Instr. 3) | 2. Transaction Date (Month/Day/Year) | 2A. Deemed Execution Date, if any (Month/Day/Year) | 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 |
|
Non-Voting Common Stock, $.01 par value
| | | | | | | |
77,500
|
D
| |
|
Common Stock, $.01 par value
| | | | | | | |
280,573.559
|
D
| |
|
Common Stock, $.01 par value
| | | | | | | |
50,000
|
I
|
Owned by David A. Brandon Foundation
|
|
Common Stock, $.01 par value
| | | | | | | |
2,483.498
|
I
|
401(K) Savings Plan
|
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 (Month/Day/Year) | 3A. Deemed Execution Date, if any (Month/Day/Year) | 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 (Month/Day/Year) | 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
| $
14
| 06/01/2009 | | D | | |
199,999
| | 07/13/2014 |
Common Stock, $.01 par value
|
199,999
|
|
0
|
D
| |
|
Option to Purchase Common Stock
| $
25.02
| 06/01/2009 | | D | | |
120,000
| | 07/29/2015 |
Common Stock, $.01 par value
|
120,000
|
|
0
|
D
| |
|
Option to Purchase Common Stock
| $
22.46
| 06/01/2009 | | D | | |
50,000
| | 07/26/2016 |
Common Stock, $.01 par value
|
50,000
|
|
0
|
D
| |
|
Option to Purchase Common Stock
| $
18.39
| 06/01/2009 | | D | | |
300,000
| | 07/18/2017 |
Common Stock, $.01 par value
|
300,000
|
|
0
|
D
| |
|
Option to Purchase Common Stock
| $
12.8
| 06/01/2009 | | D | | |
200,000
| | 01/02/2013 |
Common Stock, $.01 par value
|
200,000
|
|
0
|
D
| |
|
Option to Purchase Common Stock
| $
10.06
| 06/01/2009 | | A | |
179,999
| | 06/01/2009 | 07/13/2014 |
Common Stock, $.01 par value
|
179,999
|
$
0
|
179,999
|
D
| |
|
Option to Purchase Common Stock
| $
12.51
| 06/01/2009 | | A | |
90,000
| | 06/01/2009 | 07/29/2015 |
Common Stock, $.01 par value
|
90,000
|
$
0
|
90,000
|
D
| |
|
Option to Purchase Common Stock
| $
11.23
| 06/01/2009 | | A | |
37,500
| | 06/01/2009 | 07/26/2016 |
Common Stock, $.01 par value
|
37,500
|
$
0
|
37,500
|
D
| |
|
Option to Purchase Common Stock
| $
10.06
| 06/01/2009 | | A | |
270,000
| | | 07/18/2017 |
Common Stock, $.01 par value
|
270,000
|
$
0
|
270,000
|
D
| |
|
Option to Purchase Common Stock
| $
10.06
| 06/01/2009 | | A | |
180,000
| | | 01/02/2013 |
Common Stock, $.01 par value
|
180,000
|
$
0
|
180,000
|
D
| |
| /s/ Adam J. Gacek, attorney-in-fact | 06/03/2009 |
| ** 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 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. |