Sec Form 5 Filing - DERMASTAR INTERNATIONAL, LLC @ Imprimis Pharmaceuticals, Inc. - 2012-12-31

Insider filing report for Changes in Beneficial Ownership
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FORM 5
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
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, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(h) of the Investment Company Act of 1940
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1. Name and Address of Reporting Person
DERMASTAR INTERNATIONAL, LLC
2. Issuer Name and Ticker or Trading Symbol
Imprimis Pharmaceuticals, Inc. [ IMMY]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
_____ Director X __ 10% Owner
_____ Officer (give title below) _____ Other (specify below)
(Last) (First) (Middle)
1302 WAUGH DRIVE, STE 618
3. Date of Earliest Transaction (MM/DD/YY)
12/31/2012
(Street)
HOUSTON, TX77019
4. If Amendment, Date Original Filed (MM/DD/YY)
6. Individual or Joint/Group Filing (Check Applicable Line)
__ X __ Form filed by One Reporting Person
_____ Form filed by More than One Reporting Person
(City) (State) (Zip)
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
1.Title of Security
(Instr. 3)
2. Transaction Date (MM/DD/YY) 2A. Deemed Execution Date, if any (MM/DD/YY) 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 02/28/2012 C( 2 ) 1,454,962 A $ 0 0 ( 1 ) D
Common Stock 04/30/2012 J( 3 ) 193,047 A $ 762,534 0 ( 1 ) D
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 (MM/DD/YY) 3A. Deemed Execution Date, if any (MM/DD/YY) 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
(MM/DD/YY)
7. Title and Amount of Underlying Securities
(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 of Derivative Security: 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
Convertible Debenture $ 0.6668 01/01/2012 P 856,087 02/28/2012 04/05/2012 Common Stock 1,454,962 $ 50,000 0 D
Convertible Debenture $ 0.6668 02/28/2012 C 856,087 02/28/2012 04/05/2012 Common Stock 1,454,962 $ 0 0 ( 1 ) D
Warrants $ 5.925 04/30/2012 P 48,262 04/30/2012 04/29/2015 Common Stock 48,262 $ 0 0 ( 1 ) D
Reporting Owners
Reporting Owner Name / Address Relationships
Director 10% Owner Officer Other
DERMASTAR INTERNATIONAL, LLC
1302 WAUGH DRIVE
STE 618
HOUSTON, TX77019
X
Signatures
/s/ Mark Baum 03/15/2013
Signature of Reporting Person Date
Explanation of Responses:
( 1 )As previously reported on a Form 4 filed on July 20, 2012, on July 12, 2012, the reporting person distributed to its members all securities of the Issuer held by it and was subsequently dissolved.
( 2 )Represents the shares of common stock acquired by the reporting person upon automatic conversion of a convertible debenture issued by the Issuer on April 5, 2010 and acquired from the initial holder by the reporting person in a private transaction on January 1, 2012.
( 3 )Represents shares received upon the exchange of amounts owing under an outstanding Line of Credit into common stock of the Issuer.

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* If the form is filed by more than one reporting person, see Instruction 4(b)(v).
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