Statement of Changes in Beneficial Ownership (4)
September 16 2016 - 4:43PM
Edgar (US Regulatory)
FORM 4
[ ]
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue.
See
Instruction 1(b).
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
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OMB APPROVAL
OMB Number:
3235-0287
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
*
Kaddis Atheer A
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2. Issuer Name
and
Ticker or Trading Symbol
Diplomat Pharmacy, Inc.
[
DPLO
]
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
_____ Director
_____ 10% Owner
__
X
__ Officer (give title below)
_____ Other (specify below)
EVP of Sales & Strategic Align
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(Last)
(First)
(Middle)
4100 S. SAGINAW STREET
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3. Date of Earliest Transaction
(MM/DD/YYYY)
9/15/2016
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(Street)
FLINT, MI 48507
(City)
(State)
(Zip)
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4. 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 Acquired, Disposed of, or Beneficially Owned
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1.Title of Security
(Instr. 3)
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2. Trans. Date
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2A. Deemed Execution Date, if any
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3. Trans. Code
(Instr. 8)
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4. Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
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5. Amount of Securities Beneficially Owned Following Reported Transaction(s)
(Instr. 3 and 4)
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6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)
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7. Nature of Indirect Beneficial Ownership (Instr. 4)
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Code
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V
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Amount
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(A) or (D)
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Price
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Common Stock
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9/15/2016
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M
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20000
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A
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$3.07
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20000
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D
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Common Stock
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9/15/2016
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S
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20000
(1)
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D
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$30.1179
(2)
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0
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D
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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. 3)
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2. Conversion or Exercise Price of Derivative Security
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3. Trans. Date
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3A. Deemed Execution Date, if any
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4. Trans. Code
(Instr. 8)
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5. Number of Derivative Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
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6. Date Exercisable and Expiration Date
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7. Title and Amount of Securities Underlying Derivative Security
(Instr. 3 and 4)
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8. Price of Derivative Security
(Instr. 5)
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9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4)
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10. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 4)
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11. Nature of Indirect Beneficial Ownership (Instr. 4)
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Code
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V
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(A)
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(D)
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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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$3.07
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9/15/2016
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M
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20000
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(3)
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4/1/2019
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Common Stock
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20000
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$0
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275800
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D
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Explanation of Responses:
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(
1)
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The sale was effected pursuant to a 10b5-1 trading plan initially adopted by the reporting person on August 12, 2016. The plan provides for monthly sales of 20,000 shares of common stock at the market price. Shares that are not sold in a particular month will be available for sale in subsequent months under the plan. 100,000 shares remain available for sale under the plan, which is set to expire on March 15, 2017.
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(
2)
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The price represents the weighted average price of the multiple transactions reported on this line. The shares were sold at prices ranging from $30.00 to $30.73 per share. Upon request by the SEC staff, the issuer or any securityholder of the issuer, the reporting person will provide full information regarding the number of shares sold at each separate price.
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(
3)
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The options were granted on April 1, 2009. The options began to vest in annual increments of 25% of the option grant on the one-year anniversary of the grant date, to be fully vested after four years. 100% of the options originally granted are currently vested and exercisable.
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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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Kaddis Atheer A
4100 S. SAGINAW STREET
FLINT, MI 48507
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EVP of Sales & Strategic Align
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Signatures
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Jeffrey H. Kuras, Attorney-in-fact
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9/16/2016
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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 4(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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