0001209191-22-010194.txt : 20220216 0001209191-22-010194.hdr.sgml : 20220216 20220216161921 ACCESSION NUMBER: 0001209191-22-010194 CONFORMED SUBMISSION TYPE: 5 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20220102 FILED AS OF DATE: 20220216 DATE AS OF CHANGE: 20220216 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: ALLISON RICHARD E JR CENTRAL INDEX KEY: 0001622500 FILING VALUES: FORM TYPE: 5 SEC ACT: 1934 Act SEC FILE NUMBER: 001-32242 FILM NUMBER: 22643809 MAIL ADDRESS: STREET 1: 30 FRANK LLOYD WRIGHT DR CITY: ANN ARBOR STATE: MI ZIP: 48105 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: 48106 BUSINESS PHONE: (734) 930-3030 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 2022-01-02 0 0 0 0001286681 DOMINOS PIZZA INC DPZ 0001622500 ALLISON RICHARD E JR DOMINO'S PIZZA 30 FRANK LLOYD WRIGHT DRIVE ANN ARBOR MI 48105 1 1 0 0 Chief Executive Officer Common Stock, $0.01 par value 2021-08-18 5 G 0 200 0.00 D 43672.926 D Common Stock, $0.01 par value 2021-08-18 5 G 0 400 0.00 D 43272.926 D Common Stock, $0.01 par value 250 I Son Common Stock, $0.01 par value 250 I Daughter This transaction involved a gift of common stock of Domino's Pizza, Inc. by the Reporting Person to a charitable organization. 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/ Kevin S. Morris, attorney-in-fact 2022-02-16