0001596771-19-000011.txt : 20190214 0001596771-19-000011.hdr.sgml : 20190214 20190214155836 ACCESSION NUMBER: 0001596771-19-000011 CONFORMED SUBMISSION TYPE: 5 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20181231 FILED AS OF DATE: 20190214 DATE AS OF CHANGE: 20190214 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: 19605715 MAIL ADDRESS: STREET 1: 4100 S. SAGINAW STREET CITY: FLINT STATE: MI ZIP: 48507 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 5 1 primary_doc.xml PRIMARY DOCUMENT X0306 5 2018-12-31 0 0 0 0001610092 Diplomat Pharmacy, Inc. DPLO 0001618897 Hagerman Philip R 4100 S. SAGINAW STREET FLINT MI 48507 1 0 1 0 Common Stock 5222 D Common Stock 2018-05-30 5 G 0 50000 0 D 1280099 I Philip R. Hagerman Revocable Trust Common Stock 3391609 I 2007 Hagerman Family GST Common Stock 3600091 I The JH GST Trust Common Stock 1475876 I 2013 Irrev. Exempt Trust for Daughter Common Stock 1475876 I 2013 Irrev. Exempt Trust for Son Common Stock 1075293 I 2013 Irrev. Exempt Trust for Daughter Common Stock 1311292 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 2018-05-30 5 G 0 50000 0 D 367528 I Jocelyn 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 367256 I Irrevocable Non-Exempt Trust for Son Common Stock 367256 I Irrevocable Non-Exempt Trust for Daughter On May 30, 2018, 50,000 shares held by the Philip R. Hagerman Revocable Trust were donated to The Hagerman Foundation, an unaffiliated, nonprofit corporation. These shares are indirectly owned by Mr. Hagerman as 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, 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 Jocelyn Hagerman Living Trust, and the PH Marital Trust. On May 30, 2018, 50,000 shares held by the Jocelyn Hagerman Living Trust were donated to The Hagerman Foundation, an unaffiliated, nonprofit corporation. /s/ Christina Flint, by Power of Attorney 2019-02-14