0001140361-16-088328.txt : 20161201 0001140361-16-088328.hdr.sgml : 20161201 20161201121756 ACCESSION NUMBER: 0001140361-16-088328 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20161129 FILED AS OF DATE: 20161201 DATE AS OF CHANGE: 20161201 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Health Insurance Innovations, Inc. CENTRAL INDEX KEY: 0001561387 STANDARD INDUSTRIAL CLASSIFICATION: INSURANCE AGENTS BROKERS & SERVICES [6411] IRS NUMBER: 461282634 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 15438 N. FLORIDA AVENUE STREET 2: SUITE 201 CITY: TAMPA STATE: FL ZIP: 33613 BUSINESS PHONE: 813-280-1289 MAIL ADDRESS: STREET 1: 15438 N. FLORIDA AVENUE STREET 2: SUITE 201 CITY: TAMPA STATE: FL ZIP: 33613 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Telkamp Bruce CENTRAL INDEX KEY: 0001366007 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-35811 FILM NUMBER: 162027510 MAIL ADDRESS: STREET 1: 440 EAST MIDDLEFIELD ROAD CITY: MOUNTAIN VIEW STATE: CA ZIP: 94043 4 1 doc1.xml FORM 4 X0306 4 2016-11-29 0 0001561387 Health Insurance Innovations, Inc. HIIQ 0001366007 Telkamp Bruce C/O HEALTH INSURANCE INNOVATIONS, INC. 15438 N. FLORIDA AVE., SUITE 201 TAMPA FL 33613 1 1 0 0 CEO of HealthPocket, Inc.* Class A Common Stock 2016-11-25 5 G 0 5000 0 D 178281 D Class A Common Stock 2016-11-29 4 M 0 10000 4.95 A 188281 D Class A Common Stock 2016-11-29 4 D 0 3853 12.85 D 184428 D Class A Common Stock 2016-11-29 4 F 0 2691 12.85 D 181737 D Class A Common Stock 2016-11-29 4 S 0 3456 12.85 D 178281 D Class A Common Stock 2016-11-30 5 G 0 5000 0 D 173281 D Stock Appreciation Rights 6.77 2021-05-25 Class A Common Stock 84000 84000 D Stock Appreciation Rights 6.77 2021-05-25 Class A Common Stock 42000 42000 D Stock Appreciation Rights 12.13 2021-07-14 Class A Common Stock 10000 10000 D Stock Appreciation Rights 4.95 2016-11-29 4 M 0 10000 0 D 2022-07-01 Class A Common Stock 10000 30000 D This transaction reports a donation to a 501(c)(3) public charity. On November 29, 2016, the reporting person exercised stock appreciation rights ("SARs") relating to 10,000 shares, of which 3,853 shares were retained by the issuer to satisfy the exercise price of such SARs, 2,691 shares were withheld by the issuer to satisfy a tax liability associated with the exercise, and 3,456 of the shares were sold by the reporting person. These stock-settled stock appreciation rights were granted under the Plan and will vest as follows: (i) 42,000 on the first date on which the average trading price of the Company's Class A common stock is at or above $12.00 per share for the preceding 30 consecutive trading days, and (ii) 42,000 on the first date on which the average trading price of the Company's Class A common stock is at or above $16.00 per share for the preceding 30 consecutive trading days, all subject to the terms of the Plan and an award agreement under the Plan. These stock-settled stock appreciation rights were previously granted under the Plan and will vest (either wholly or partially) based on the extent to which certain financial performance targets established by the Company's Board of Directors are achieved for the 2016 fiscal year. These stock-settled stock appreciation rights were previously granted under the Issuer's Long-Term Incentive Plan and are scheduled to vest in increments of 20%, 20%, 20%, and 40% on successive anniversary dates of the grant, subject to the terms of the plan and an award agreement under the plan. These stock-settled stock appreciation rights were previously granted under the Issuer's Long-Term Incentive Plan (the "Plan") and are scheduled to vest in increments of 25%, 25%, and 50% on successive anniversary dates of the grant, subject to the terms of the Plan and an award agreement under the Plan. * HealthPocket, Inc. is a subsidiary of Issuer. /s/ Michael Hershberger, Attorney-in-Fact for Bruce Telkamp 2016-12-01