SEC Form 4
FORM 4 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP

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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Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
1. Name and Address of Reporting Person*
Hagerman Philip R

(Last) (First) (Middle)
4100 S. SAGINAW STREET

(Street)
FLINT MI 48507

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
Diplomat Pharmacy, Inc. [ DPLO ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director X 10% Owner
X Officer (give title below) Other (specify below)
Chairman and CEO
3. Date of Earliest Transaction (Month/Day/Year)
12/07/2015
4. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
X Form filed by One Reporting Person
Form filed by More than One Reporting Person
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
1. Title of Security (Instr. 3) 2. Transaction Date (Month/Day/Year) 2A. Deemed Execution Date, if any (Month/Day/Year) 3. Transaction Code (Instr. 8) 4. Securities Acquired (A) or Disposed Of (D) (Instr. 3, 4 and 5) 5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4) 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 7. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V Amount (A) or (D) Price
Common Stock 1,462,145 I Philip R. Hagerman Revocable Trust (1)
Common Stock 3,891,609 I 2007 Hagerman Family GST (2)
Common Stock 4,450,091 I The JH GST Trust (1)
Common Stock 12/07/2015 S 230,000 D $33.6 1,550,876 I 2013 Irrev Exempt Trust for Daughter (2)
Common Stock 12/07/2015 S 230,000 D $33.6 1,550,876 I 2013 Irrev Exempt Trust for Son (2)
Common Stock 12/07/2015 S 376,000 D $33.6 1,215,293 I 2013 Irrev Exempt Trust for Daughter (1)
Common Stock 12/07/2015 S 220,000 D $33.6 1,371,292 I 2013 Irrev Exempt Trust for Daughter (1)
Common Stock 12/07/2015 S 311,000 D $33.6 313,337 I 2014 Irrev Exempt Trust for Son (2)
Common Stock 12/07/2015 S 311,000 D $33.6 313,337 I 2014 Irrev Exempt Trust for Daughter (2)
Common Stock 12/07/2015 S 311,000 D $33.6 313,337 I 2014 Irrev Exempt Trust for Daughter (1)
Common Stock 12/07/2015 S 311,000 D $33.6 313,337 I 2014 Irrev Exempt Trust for Daughter (1)
Common Stock 1,073,336 I Philip Hagerman 2014 GRAT (2)
Common Stock 1,073,336 I Jocelyn Hagerman 2014 GRAT (1)
Common Stock 357,836 I Jocelyn Hagerman Living Trust (2)
Common Stock 263,500 I JH Marital Trust (1)
Common Stock 272,000 I PH Marital Trust (2)
Common Stock 394,910 I Irrev Trust for Son
Common Stock 394,910 I Irrev Trust for Daughter
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 3) 2. Conversion or Exercise Price of Derivative Security 3. Transaction Date (Month/Day/Year) 3A. Deemed Execution Date, if any (Month/Day/Year) 4. Transaction Code (Instr. 8) 5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) 6. Date Exercisable and Expiration Date (Month/Day/Year) 7. Title and Amount of Securities Underlying Derivative Security (Instr. 3 and 4) 8. Price of Derivative Security (Instr. 5) 9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) 10. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 11. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V (A) (D) Date Exercisable Expiration Date Title Amount or Number of Shares
Explanation of Responses:
1. These shares are indirectly owned by Mr. Hagerman as the trustee of the Philip R. Hagerman Revocable 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.
2. 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.
Jeffrey H. Kuras, by Power of Attorney 12/08/2015
** 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 4 (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.