0001209191-23-051896.txt : 20231004
0001209191-23-051896.hdr.sgml : 20231004
20231004160739
ACCESSION NUMBER: 0001209191-23-051896
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20231002
FILED AS OF DATE: 20231004
DATE AS OF CHANGE: 20231004
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: BALSON ANDREW
CENTRAL INDEX KEY: 0001212449
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-32242
FILM NUMBER: 231307962
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: DOMINOS PIZZA INC
CENTRAL INDEX KEY: 0001286681
STANDARD INDUSTRIAL CLASSIFICATION: WHOLESALE-GROCERIES & RELATED PRODUCTS [5140]
IRS NUMBER: 382511577
STATE OF INCORPORATION: DE
FISCAL YEAR END: 0102
BUSINESS ADDRESS:
STREET 1: 30 FRANK LLOYD WRIGHT DRIVE
CITY: ANN ARBOR
STATE: MI
ZIP: 48105
BUSINESS PHONE: (734) 930-3030
MAIL ADDRESS:
STREET 1: 30 FRANK LLOYD WRIGHT DRIVE
CITY: ANN ARBOR
STATE: MI
ZIP: 48105
4
1
doc4.xml
FORM 4 SUBMISSION
X0508
4
2023-10-02
0
0001286681
DOMINOS PIZZA INC
DPZ
0001212449
BALSON ANDREW
C/O DOMINO'S PIZZA
30 FRANK LLOYD WRIGHT DRIVE
ANN ARBOR
MI
48105
1
0
0
0
0
Common Stock, $0.01 par value
2023-10-02
4
A
0
69
0.00
A
21728
D
Common Stock, $0.01 par value
25310
I
Andrew B. Balson 2004 Irrevocable Family Trust
Common Stock, $0.01 par value
6870
I
Andrew B. Balson 2011 Irrevocable Family Trust
Represents restricted stock units awarded pursuant to Mr. Balson's election to receive his cash retainer fees in the form of Company stock, and to defer distribution of such restricted stock units, pursuant to the Amended and Restated Domino's Pizza Deferred Compensation Plan dated October 11, 2022.
/s/ Kevin S. Morris, attorney-in-fact
2023-10-04