0001104659-17-009362.txt : 20170214
0001104659-17-009362.hdr.sgml : 20170214
20170214170640
ACCESSION NUMBER: 0001104659-17-009362
CONFORMED SUBMISSION TYPE: 5
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20161231
FILED AS OF DATE: 20170214
DATE AS OF CHANGE: 20170214
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: Diplomat Pharmacy, Inc.
CENTRAL INDEX KEY: 0001610092
STANDARD INDUSTRIAL CLASSIFICATION: RETAIL-DRUG STORES AND PROPRIETARY STORES [5912]
IRS NUMBER: 382063100
STATE OF INCORPORATION: MI
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 4100 S. SAGINAW ST.
CITY: FLINT
STATE: MI
ZIP: 48507
BUSINESS PHONE: 888-720-4450
MAIL ADDRESS:
STREET 1: 4100 S. SAGINAW ST.
CITY: FLINT
STATE: MI
ZIP: 48507
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Hagerman Philip R
CENTRAL INDEX KEY: 0001618897
FILING VALUES:
FORM TYPE: 5
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-36677
FILM NUMBER: 17610281
MAIL ADDRESS:
STREET 1: 4100 S. SAGINAW STREET
CITY: FLINT
STATE: MI
ZIP: 48507
5
1
a5.xml
5
X0306
5
2016-12-31
0
0
0
0001610092
Diplomat Pharmacy, Inc.
DPLO
0001618897
Hagerman Philip R
4100 S. SAGINAW ST.
FLINT
MI
48507
1
1
1
0
Chairman and CEO
Common Stock
1499756
I
Philip R. Hagerman Revocable Trust
Common Stock
3891609
I
2007 Hagerman Family GST Trust
Common Stock
4450091
I
The JH GST Trust
Common Stock
1550876
I
2013 Irrev. Exempt Trust for Daughter
Common Stock
1550876
I
2013 Irrev. Exempt Trust for Son
Common Stock
1215293
I
2013 Irrev. Exempt Trust for Daughter
Common Stock
1371292
I
2013 Irrev. Exempt Trust for Daughter
Common Stock
313337
I
2014 Irrev. Exempt Trust for Son
Common Stock
313337
I
2014 Irrev. Exempt Trust for Daughter
Common Stock
313337
I
2014 Irrev. Exempt Trust for Daughter
Common Stock
313337
I
2014 Irrev. Exempt Trust for Daughter
Common Stock
2016-08-24
5
G
0
734513
0
D
0
I
Philip Hagerman 2014 GRAT
Common Stock
2016-08-24
5
G
0
734513
0
D
0
I
Jocelyn Hagerman 2014 GRAT
Common Stock
696659
I
Jocelyn Hagerman Living Trust
Common Stock
301212
I
Philip R. Hagerman Living Trust
Common Stock
263500
I
JH Marital Trust
Common Stock
272000
I
PH Marital Trust
Common Stock
394910
I
Irrevocable Trust for Son
Common Stock
394910
I
Irrevocable Trust for Daughter
Common Stock
2016-08-24
5
G
0
367256
0
A
367256
I
Irrevocable Non-Exempt Trust for Son
Common Stock
2016-08-24
5
G
0
367256
0
A
367256
I
Irrevocable Non-Exempt Trust for Daughter
On July 8, 2016, 338,823 shares held by the Philip Hagerman 2014 GRAT ("PH GRAT") were transferred to the Philip R. Hagerman Revocable Trust, and upon termination of the PH GRAT on August 24, 2016, the remaining 734,513 shares were transferred to trusts established for the reporting person's four children.
These shares are indirectly owned by Mr. Hagerman as the trustee of the Philip R. Hagerman Revocable Trust, the Philip R. Hagerman Living Trust, The JH GST Trust, the 2013 Irrevocable Exempt Trusts and 2014 Irrevocable Exempt Trusts for two daughters, the Jocelyn Hagerman 2014 GRAT and the JH Marital Trust.
Jocelyn Hagerman is Mr. Hagerman's wife. These shares are indirectly owned by her as a trustee of the 2007 Hagerman Family GST Trust, the 2013 Irrevocable Exempt Trusts and 2014 Irrevocable Exempt Trusts for a son and daughter, the Philip Hagerman 2014 GRAT, the Jocelyn Hagerman Living Trust and the PH Marital Trust.
On July 8, 2016, 338,823 shares held by the Jocelyn Hagerman 2014 GRAT ("JH GRAT") were transferred to the Jocelyn Hagerman Living Trust, and upon termination of the JH GRAT on August 24, 2016, the remaining 734,513 shares were transferred to trusts established for Mrs. Hagerman's four children.
Jeffrey H. Kuras, by Power of Attorney
2017-02-14