0001209191-21-028993.txt : 20210429 0001209191-21-028993.hdr.sgml : 20210429 20210429160802 ACCESSION NUMBER: 0001209191-21-028993 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20210427 FILED AS OF DATE: 20210429 DATE AS OF CHANGE: 20210429 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: 21870549 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: DOMINOS PIZZA INC CENTRAL INDEX KEY: 0001286681 STANDARD INDUSTRIAL CLASSIFICATION: WHOLESALE-GROCERIES & RELATED PRODUCTS [5140] IRS NUMBER: 382511577 FISCAL YEAR END: 1229 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 4 1 doc4.xml FORM 4 SUBMISSION X0306 4 2021-04-27 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 Common Stock, $0.01 par value 2021-04-27 4 A 0 399 0.00 A 43122 D Common Stock, $0.01 par value 27310 I Andrew B. Balson 2004 Irrevocable Family Trust Common Stock, $0.01 par value 8870 I Andrew B. Balson 2011 Irrevocable Family Trust Represents a grant of restricted stock that shall vest 100% on the first anniversary of the issuance date. Thus, all shares shall vest on April 27, 2022. /s/ Kevin S. Morris, attorney-in-fact 2021-04-29