Initial Statement of Beneficial Ownership (3)
13 Mai 2019 - 11:05PM
Edgar (US Regulatory)
FORM 3
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES
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OMB APPROVAL
OMB Number:
3235-0104
Estimated average burden
hours per response...
0.5
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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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1. Name and Address of Reporting Person
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Loschinskey Dave
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2. Date of Event Requiring Statement (MM/DD/YYYY)
5/2/2019
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3. Issuer Name
and
Ticker or Trading Symbol
Diplomat Pharmacy, Inc. [DPLO]
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(Last)
(First)
(Middle)
C/O DIPLOMAT PHARMACY, INC., 4100 SOUTH SAGINAW ST.
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4. Relationship of Reporting Person(s) to Issuer (Check all applicable)
_____ Director
_____ 10% Owner
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X
___ Officer (give title below)
_____ Other (specify below)
Chief Operating Officer /
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(Street)
FLINT, MI 48507
(City)
(State)
(Zip)
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5. If Amendment, Date Original Filed
(MM/DD/YYYY)
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6. Individual or Joint/Group Filing
(Check Applicable Line)
_
X
_ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person
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Table I - Non-Derivative Securities Beneficially Owned
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1.Title of Security
(Instr. 4)
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2. Amount of Securities Beneficially Owned
(Instr. 4)
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3. Ownership Form: Direct (D) or Indirect (I)
(Instr. 5)
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4. Nature of Indirect Beneficial Ownership
(Instr. 5)
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Common Stock
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100822
(1)
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D
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Common Stock
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994
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I
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By Spouse
(2)
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Table II - Derivative Securities Beneficially Owned (
e.g.
, puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security
(Instr. 4)
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2. Date Exercisable and Expiration Date
(MM/DD/YYYY)
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3. Title and Amount of Securities Underlying Derivative Security
(Instr. 4)
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4. Conversion or Exercise Price of Derivative Security
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5. Ownership Form of Derivative Security: Direct (D) or Indirect (I)
(Instr. 5)
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6. Nature of Indirect Beneficial Ownership
(Instr. 5)
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Date Exercisable
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Expiration Date
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Title
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Amount or Number of Shares
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Employee Stock Option to Acquire Common Stock
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(3)
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11/6/2027
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Common Stock
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100000
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$20.87
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D
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Employee Stock Option to Acquire Common Stock
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(4)
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3/27/2028
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Common Stock
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9508
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$20.52
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D
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Explanation of Responses:
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(1)
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Includes 1,778 restricted stock units granted in connection with the Issuer's equity incentive plan, one half of which will vest on March 27, 2020 and one half of which will vest on March 27, 2021.
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(2)
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Shares held directly by the Reporting Person's spouse.
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(3)
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The options were granted on November 6, 2017, in connection with the Reporting Person joining the Issuer, under the Issuer's equity incentive plan. One-fourth of the options vested on November 6, 2018 and the remaining three-fourths will vest on each of the second, third and fourth anniversary of the grant date.
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(4)
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The options were granted on March 27, 2018 in connection with the Issuer's equity incentive plan. One-third of the options vested on March 27, 2019 and the remaining two-thirds will vest on each of the second and third anniversary of the grant date.
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Reporting Owners
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Reporting Owner Name / Address
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Relationships
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Director
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10% Owner
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Officer
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Other
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Loschinskey Dave
C/O DIPLOMAT PHARMACY, INC.
4100 SOUTH SAGINAW ST.
FLINT, MI 48507
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Chief Operating Officer
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Signatures
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/s/ Christina Flint, by Power of Attorney
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5/13/2019
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**
Signature of Reporting Person
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Date
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
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*
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If the form is filed by more than one reporting person,
see
Instruction 5(b)(v).
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**
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Intentional misstatements or omissions of facts constitute Federal Criminal Violations.
See
18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
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Note:
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File three copies of this Form, one of which must be manually signed. If space is insufficient,
see
Instruction 6 for procedure.
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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 control number.
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