SEC Form 5 · accession 0001104659-17-009362
Diplomat Pharmacy, Inc. · DPLO
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Philip R Hagerman
Officer — Chairman and CEO · Director · 10% Owner
Period of report
Dec 31, 2016
Accepted (ET)
Feb 14, 2017 · 5:06 pm EST
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0001610092
Table I — non-derivative securities
| Security | Date | Code | Shares | Price | A/D | Owned after | D/I | Nature of ownership |
|---|---|---|---|---|---|---|---|---|
| Common StockF1,F3 | Aug 24, 2016 | G | 734,513 | $0.00 | D | 0 | I | Philip Hagerman 2014 GRAT |
| Common StockF4,F2 | Aug 24, 2016 | G | 734,513 | $0.00 | D | 0 | I | Jocelyn Hagerman 2014 GRAT |
| Common StockF1,F4 | Aug 24, 2016 | G | 367,256 | $0.00 | A | 367,256 | I | Irrevocable Non-Exempt Trust for Son |
| Common StockF1,F4 | Aug 24, 2016 | G | 367,256 | $0.00 | A | 367,256 | I | Irrevocable Non-Exempt Trust for Daughter |
| Common StockF1,F2 | holding | — | — | — | 1,499,756 | I | Philip R. Hagerman Revocable Trust | |
| Common StockF3 | holding | — | — | — | 3,891,609 | I | 2007 Hagerman Family GST Trust | |
| Common StockF2 | holding | — | — | — | 4,450,091 | I | The JH GST Trust | |
| Common StockF3 | holding | — | — | — | 1,550,876 | I | 2013 Irrev. Exempt Trust for Daughter | |
| Common StockF3 | holding | — | — | — | 1,550,876 | I | 2013 Irrev. Exempt Trust for Son | |
| Common StockF2 | holding | — | — | — | 1,215,293 | I | 2013 Irrev. Exempt Trust for Daughter | |
| Common StockF2 | holding | — | — | — | 1,371,292 | I | 2013 Irrev. Exempt Trust for Daughter | |
| Common StockF3 | holding | — | — | — | 313,337 | I | 2014 Irrev. Exempt Trust for Son | |
| Common StockF3 | holding | — | — | — | 313,337 | I | 2014 Irrev. Exempt Trust for Daughter | |
| Common StockF2 | holding | — | — | — | 313,337 | I | 2014 Irrev. Exempt Trust for Daughter | |
| Common StockF2 | holding | — | — | — | 313,337 | I | 2014 Irrev. Exempt Trust for Daughter | |
| Common StockF4,F3 | holding | — | — | — | 696,659 | I | Jocelyn Hagerman Living Trust | |
| Common StockF2 | holding | — | — | — | 301,212 | I | Philip R. Hagerman Living Trust | |
| Common StockF2 | holding | — | — | — | 263,500 | I | JH Marital Trust | |
| Common StockF3 | holding | — | — | — | 272,000 | I | PH Marital Trust | |
| Common Stock | holding | — | — | — | 394,910 | I | Irrevocable Trust for Son | |
| Common Stock | holding | — | — | — | 394,910 | I | Irrevocable Trust for Daughter |
Table II — derivative securities
No Table II lines on this filing.
Explanation of responses
- F1On 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.
- F2These 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.
- F3Jocelyn 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.
- F4On 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.