SEC Form 4 · accession 0001140361-15-023823
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, Gen. Counsel & Secy
Period of report
Jun 8, 2015
Accepted (ET)
Jun 10, 2015 · 5:31 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 |
|---|---|---|---|---|---|---|---|---|
| Class A Common StockF1 | holding | — | — | — | 43,520 | 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 | $4.72 | Jun 8, 2015 | A | 25,000 | A | — | Jun 8, 2022 | Class A Common Stock | 25,000 | 25,000 | D |
| Stock Appreciation RightsF3 | $11.75 | holding | — | — | — | — | Oct 28, 2020 | Class A Common Stock | 175,000 | 175,000 | D |
Explanation of responses
- F1Includes shares of restricted stock granted pursuant to the Issuer's Long Term Incentive Plan which have fully vested pursuant to the terms of a separation agreement between the Reporting Person and the Issuer.
- F2These stock-settled stock appreciation rights were granted under the Issuer's Long-Term Incentive Plan and will vest upon successful completion of Reporting Person's employment transition period, which is expected to be August 31, 2015.
- F3Stock Appreciation Rights awarded pursuant to the issuer's Long Term Incentive Plan which have already vested or are scheduled to vest (excluding 25,000 of the rights) on the Reporting Person's last day of employment with the Issuer, which is anticipated to be August 31, 2015.