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