SEC Form 4 · accession 0001209191-19-007383
DOMINOS PIZZA INC · DPZ
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Andrew Balson
Director
Period of report
Feb 1, 2019
Accepted (ET)
Feb 5, 2019 · 4:50 pm EST
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0001286681
Table I — non-derivative securities
| Security | Date | Code | Shares | Price | A/D | Owned after | D/I | Nature of ownership |
|---|---|---|---|---|---|---|---|---|
| Common Stock, $0.01 par valueF1 | Feb 1, 2019 | M | 20,000 | $6.59 | A | 50,833 | D | |
| Common Stock, $0.01 par value | holding | — | — | — | 27,310 | I | Andrew B. Balson 2004 Irrevocable Family Trust | |
| Common Stock, $0.01 par value | holding | — | — | — | 8,870 | I | Andrew B. Balson 2011 Irrevocable Family Trust |
Table II — derivative securities
| Security | Conv. / exercise price | Date | Code | Shares | A/D | Exercisable | Expires | Underlying | Underlying shares | Owned after | D/I |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Option to Purchase Common Stock | $6.59 | Feb 1, 2019 | M | 20,000 | D | Feb 10, 2010 | Feb 10, 2019 | Common Stock, $0.01 par value | 20,000 | 0 | D |
Explanation of responses
- F1Represents the acquisition of common stock resulting from the exercise and hold of derivative securities reported in Table II.