FORM 3 |
UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 or Section 30(h) of the Investment Company Act of 1940 |
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1. Name and Address of Reporting Person*
(Street)
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2. Date of Event Requiring Statement
(Month/Day/Year) 11/01/2016 |
3. Issuer Name and Ticker or Trading Symbol
Diplomat Pharmacy, Inc. [ DPLO ] |
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4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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5. If Amendment, Date of Original Filed
(Month/Day/Year) |
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6. Individual or Joint/Group Filing (Check Applicable Line)
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Table I - Non-Derivative Securities Beneficially Owned | |||
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1. Title of Security (Instr. 4) | 2. Amount of Securities Beneficially Owned (Instr. 4) | 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) | 4. Nature of Indirect Beneficial Ownership (Instr. 5) |
Common Stock | 3,194 | D |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||
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1. Title of Derivative Security (Instr. 4) | 2. Date Exercisable and Expiration Date (Month/Day/Year) | 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) | 4. Conversion or Exercise Price of Derivative Security | 5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) | 6. Nature of Indirect Beneficial Ownership (Instr. 5) | ||
Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||
Employee Stock Option to Acquire Common Stock | (1) | 06/19/2025 | Common Stock | 100,000 | $44.39 | D | |
Employee Stock Option to Acquire Common Stock | (2) | 07/10/2025 | Common Stock | 33,448 | $48.64 | D | |
Employee Stock Option to Acquire Common Stock | (3) | 01/27/2026 | Common Stock | 50,000 | $29.95 | D | |
Employee Stock Option to Acquire Common Stock | (4) | 02/12/2026 | Common Stock | 25,000 | $29.73 | D | |
Employee Stock Option to Acquire Common Stock | (5) | 03/21/2026 | Common Stock | 14,961 | $25.92 | D |
Explanation of Responses: |
1. The options were granted on June 19, 2015. The options began to vest in annual increments of 25% of the option grant on the one-year anniversary of the grant date, to be fully vested after four years. 25% of the options originally granted are currently vested and exercisable. |
2. The options were granted on July 10, 2015. The options began to vest in annual increments of 25% of the option grant on the one-year anniversary of the grant date, to be fully vested after four years. 25% of the options originally granted are currently vested and exercisable. |
3. The options were granted on January 27, 2016. The options will begin to vest in annual increments of 25% of the option grant on the one-year anniversary of the grant date, to be fully vested after four years. |
4. The options were granted on February 12, 2016. The options will begin to vest in annual increments of 25% of the option grant on the one-year anniversary of the grant date, to be fully vested after four years. |
5. The options were granted on March 21, 2016, and vest according to certain financial performance criteria of the Company. To the extent such criteria are met, the options will vest in annual increments of 25% of the option grant beginning on March 31, 2017, to be fully vested after four years. |
Remarks: |
Exhibit 24, Power of Attorney, is attached. |
Jeffrey H. Kuras, Attorney-in-fact | 11/01/2016 | |
** Signature of Reporting Person | Date | |
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | ||
* If the form is filed by more than one reporting person, see Instruction 5 (b)(v). | ||
** Intentional misstatements or omissions of facts constitute Federal Criminal Violations See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). | ||
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure. | ||
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number. |