SEC Form 4 · accession 0001140361-17-026543
HEALTHEQUITY, INC. · HQY
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Michael O Leavitt
Director
Period of report
Jun 26, 2017
Accepted (ET)
Jun 28, 2017 · 9:40 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 StockF1 | Jun 26, 2017 | A | 430 | $0.00 | A | 30,862 | D | |
| Common StockF2 | holding | — | — | — | 13,767 | I | See footnote |
Table II — derivative securities
| Security | Conv. / exercise price | Date | Code | Shares | A/D | Exercisable | Expires | Underlying | Underlying shares | Owned after | D/I |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Stock Option (right to buy)F3 | $46.40 | holding | — | — | — | — | Feb 1, 2027 | Common Stock | 4,837 | 4,837 | D |
| Stock Option (right to buy)F3 | $21.27 | holding | — | — | — | — | Feb 1, 2026 | Common Stock | 15,000 | 15,000 | D |
| Stock Option (right to buy)F3 | $25.39 | holding | — | — | — | — | Mar 26, 2025 | Common Stock | 15,000 | 15,000 | D |
| Stock Option (right to buy)F3 | $14.00 | holding | — | — | — | — | Jul 30, 2024 | Common Stock | 15,000 | 15,000 | D |
Explanation of responses
- F1Includes 217 shares underlying restricted stock units previously reported in Table II.
- F2Shares held directly by Third Chapter, Inc. ("Third Chapter"), an entity controlled by the reporting person. The reporting person disclaims beneficial ownership of the shares held by Third Chapter except to the extent of his pecuniary interest therein and this report shall not be deemed an admission that the reporting person is the beneficial owner of the shares held by Third Chapter for any other purposes.
- F3The option is immediately exercisable.
Remarks
The Power of Attorney given by Mr. Leavitt was previously filed with the U.S. Securities & Exchange Commission on February 3, 2017, as an exhibit to a statement on Form 4 filed by Mr. Leavitt with respect to HealthEquity, Inc. and is hereby incorporated by reference.