SEC Form 4 · accession 0001140361-16-072915
Health Insurance Innovations, Inc. · HIIQ
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Michael D Hershberger
Officer — CFO, Secretary and Treasurer
Period of report
Jul 1, 2016
Accepted (ET)
Jul 20, 2016 · 5:01 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 Stock | Jul 1, 2016 | F | 4,322 | $4.38 | D | 165,140 | 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,F3 | $10.45 | holding | — | — | — | — | May 21, 2021 | Common Stock | 25,000 | 25,000 | D |
| Stock Appreciation RIghtsF3 | $4.95 | holding | — | — | — | — | Jul 1, 2022 | Common Stock | 30,000 | 30,000 | D |
| Stock Appreciation RIghtsF3 | $4.99 | holding | — | — | — | — | Sep 16, 2022 | Common Stock | 30,000 | 30,000 | D |
Explanation of responses
- F1Represents withholding of shares by Issuer to satisfy tax liability of Reporting Person incident to vesting of restricted stock.
- F2Reflects a grant of stock-settled stock appreciation rights made on a date on which the reporting person was not then serving as a Section 16 reporting officer of the Issuer.
- F3These stock-settled stock appreciation rights were granted under 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.