0001209191-18-009574.txt : 20180213 0001209191-18-009574.hdr.sgml : 20180213 20180213164415 ACCESSION NUMBER: 0001209191-18-009574 CONFORMED SUBMISSION TYPE: 5 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20171231 FILED AS OF DATE: 20180213 DATE AS OF CHANGE: 20180213 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: GOLDMAN JAMES A CENTRAL INDEX KEY: 0001194070 FILING VALUES: FORM TYPE: 5 SEC ACT: 1934 Act SEC FILE NUMBER: 001-32242 FILM NUMBER: 18604154 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: DOMINOS PIZZA INC CENTRAL INDEX KEY: 0001286681 STANDARD INDUSTRIAL CLASSIFICATION: WHOLESALE-GROCERIES & RELATED PRODUCTS [5140] IRS NUMBER: 382511577 BUSINESS ADDRESS: STREET 1: 30 FRANK LLOYD WRIGHT DRIVE CITY: ANN ARBOR STATE: MI ZIP: 48106 MAIL ADDRESS: STREET 1: 30 FRANK LLOYD WRIGHT DRIVE CITY: ANN ARBOR STATE: MI ZIP: 48106 5 1 doc5.xml FORM 5 SUBMISSION X0306 5 2017-12-31 0 0 0 0001286681 DOMINOS PIZZA INC DPZ 0001194070 GOLDMAN JAMES A DOMINO'S PIZZA 30 FRANK LLOYD WRIGHT DRIVE ANN ARBOR MI 48105 1 0 0 0 Common Stock, $0.01 par value 2017-11-29 5 G 0 66 0.00 D 9698 D Common Stock, $0.01 par value 2017-11-30 5 G 0 1050 0.00 D 8648 D Common Stock, $0.01 par value 2017-12-01 5 G 0 803 0.00 D 7845 D This transaction involved a gift of common stock of Domino's Pizza, Inc. by Mr. Goldman to charity. The transaction is exempt from Section 16(b) of the Securities Exchange Act of 1934, as amended (the "Act"), pursuant to Rule 16b-5 of the Act. /s/ Adam J. Gacek, attorney-in-fact 2018-02-13