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