SEC Form 4 · accession 0001104659-16-143303
HEALTHEQUITY, INC. · HQY
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Adrian T Dillon
Director
Period of report
Sep 1, 2016
Accepted (ET)
Sep 6, 2016 · 8:02 pm EDT
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0001428336
Table I — non-derivative securities
| Security | Date | Code | Shares | Price | A/D | Owned after | D/I | Nature of ownership |
|---|---|---|---|---|---|---|---|---|
| Common Stock | Sep 1, 2016 | A | 205 | $0.00 | A | 205 | D |
Table II — derivative securities
| Security | Conv. / exercise price | Date | Code | Shares | A/D | Exercisable | Expires | Underlying | Underlying shares | Owned after | D/I |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Restricted Stock UnitF1,F2 | — | Sep 1, 2016 | A | 308 | A | — | — | Common Stock | 308 | 308 | D |
| Restricted Stock UnitF1,F3 | — | Sep 1, 2016 | A | 2,538 | A | — | — | Common Stock | 2,538 | 2,538 | D |
| Stock Option (right to buy)F4 | $32.50 | Sep 1, 2016 | A | 7,632 | A | — | Sep 1, 2026 | Common Stock | 7,632 | 7,632 | D |
Explanation of responses
- F1Each restricted stock unit represents a contingent right to receive one share of the issuer's common stock.
- F2The restricted stock units vest on November 1, 2016. Vested shares will be delivered to the reporting person upon vesting.
- F3The restricted stock units vest in three equal annual installments of 846 shares on September 1, 2017, 2018, and 2019. Vested shares will be delivered to the reporting person upon vesting.
- F4The option becomes exercisable in three equal annual installments of 2,544 shares on September 1, 2017, 2018, and 2019.
Remarks
The Power of Attorney given by Mr. Dillon was previously filed with the U.S. Securities & Exchange Commission on September 6, 2016 as an exhibit to a statement on Form 3 filed by Mr. Dillon with respect to HealthEquity, Inc. and is hereby incorporated by reference.