SEC Form 4 · accession 0001140361-15-021367
Health Insurance Innovations, Inc. · HIIQ
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Michael A. Petrizzo Jr.
Officer — Exec. VP and General Counsel
Period of report
Oct 28, 2014
Accepted (ET)
May 21, 2015 · 4:20 pm EDT
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0001561387
Table I — non-derivative securities
| Security | Date | Code | Shares | Price | A/D | Owned after | D/I | Nature of ownership |
|---|---|---|---|---|---|---|---|---|
| Common Stock | Oct 28, 2014 | F | 1,480 | $9.71 | D | 23,520 | D |
Table II — derivative securities
| Security | Conv. / exercise price | Date | Code | Shares | A/D | Exercisable | Expires | Underlying | Underlying shares | Owned after | D/I |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Stock Appreciation RightsF2 | $11.75 | holding | — | — | — | — | Oct 28, 2020 | Class A Common Stock | 175,000 | 175,000 | D |
Explanation of responses
- F1Represents withholding of shares by Issuer to satisfy tax liability of Reporting Person incident to vesting of restricted stock, which was inadvertently reported late on this Form 4.
- F2These stock settled stock appreciation rights were granted under the Issuer's Long Term Incentive Plan and are scheduled to vest in increments of 20%, 20%, 20% and 40% on the successive anniversary dates of the grant, subject to the terms of the plan and an award agreement under the plan.