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