SEC FORM 3 SEC Form 3
FORM 3 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES

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*
DERMASTAR INTERNATIONAL, LLC

(Last) (First) (Middle)
1302 WAUGH DRIVE
STE 618

(Street)
HOUSTON TX 77019

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
12/12/2011
3. Issuer Name and Ticker or Trading Symbol
Imprimis Pharmaceuticals, Inc. [ IMMY ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director X 10% Owner
Officer (give title below) Other (specify below)
5. 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 Beneficially Owned
1. Title of Security (Instr. 4) 2. Amount of Securities Beneficially Owned (Instr. 4) 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 4. Nature of Indirect Beneficial Ownership (Instr. 5)
Common Stock(1) 8,240,045 D
Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 4) 2. Date Exercisable and Expiration Date (Month/Day/Year) 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) 4. Conversion or Exercise Price of Derivative Security 5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 6. Nature of Indirect Beneficial Ownership (Instr. 5)
Date Exercisable Expiration Date Title Amount or Number of Shares
Series A Convertible Preferred Stock(2) 02/28/2012 02/28/2012 Common Stock 7,498,500 0.0017 D
Warrants(3) 04/30/2012 04/29/2015 Common Stock 241,308 1.185 D
Explanation of Responses:
1. DermaStar International, LLC ("DermaStar") is the direct beneficial owner of 8,240,045 shares of the Issuer's common stock. Mr. Mark L. Baum and Mr. Robert Kammer are the managing members of DermaStar, and each holds an ownership interest in DermaStar, and as managing members of DermaStar, may be deemed to have voting and dispositive power over the 8,240,045 shares of common stock owned by DermaStar. Both Mr. Baum and Mr. Kammer disclaim beneficial ownership over such shares.
2. DermaStar is the direct beneficial owner of 10 shares of the Issuer's Series A Convertible Preferred Stock (the "Series A Preferred"). The Series A Preferred are convertible into a total of 7,498,500 shares of Common Stock. Mr. Baum and Mr. Kammer are the managing members of DermaStar, and each holds an ownership interest in DermaStar, and as managing members of DermaStar, may be deemed to have voting and dispositive power of the 7,498,500 shares of Common Stock underlying the Series A Preferred owned by DermaStar. Both Mr. Baum and Mr. Kammer disclaim beneficial ownership over such shares.
3. DermaStar is the direct beneficial owner of warrants to purchase up to 241,308 shares of the Issuer's Common Stock at an exercise price of $1.185 (the "Warrants"). The Warrants expire on the third anniversary of the issuance date. Mr. Baum and Mr. Kammer are the managing members of DermaStar, and each holds an ownership interest in DermaStar, and as managing members of DermaStar, may be deemed to have voting and dispositive power of the Warrants and 241,308 shares of Common Stock underlying the Warrants owned by DermaStar. Both Mr. Baum and Mr. Kammer disclaim beneficial ownership over such shares.
Mark L. Baum 04/27/2012
** 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 5 (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).
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