SEC Form 4 · accession 0001140361-16-087436
Health Insurance Innovations, Inc. · HIIQ
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Bruce Telkamp
Officer — CEO of HealthPocket, Inc.*
Period of report
Nov 17, 2016
Accepted (ET)
Nov 21, 2016 · 5:09 pm EST
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 | Nov 17, 2016 | S | 31,720 | $10.272 | D | 183,281 | D | |
| Class A Common Stock | Nov 18, 2016 | S | 26,890 | $10.00 | D | 156,391 | D | |
| Class A Common Stock | Nov 21, 2016 | S | 390 | $10.561 | D | 156,001 | 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 | $6.77 | holding | — | — | — | — | May 25, 2021 | Class A Common Stock | 84,000 | 84,000 | D |
| Stock Appreciation RightsF3 | $6.77 | holding | — | — | — | — | May 25, 2021 | Class A Common Stock | 42,000 | 42,000 | D |
| Stock Appreciation RightsF4 | $12.13 | holding | — | — | — | — | Jul 14, 2021 | Class A Common Stock | 10,000 | 10,000 | D |
| Stock Appreciation RightsF5 | $4.95 | holding | — | — | — | — | Jul 1, 2022 | Class A Common Stock | 40,000 | 40,000 | D |
Explanation of responses
- F1The price in Column 4 is a weighted average price. The prices actually received ranged from $10.25 to $10.675. The reporting person has provided to the issuer, and will provide to any security holder of the issuer, or the SEC staff, upon request, information regarding the number of shares sold at each price within the range for all transactions reported in this Form 4 utilizing a weighted average price.
- F2These stock-settled stock appreciation rights were granted under the Plan and will vest as follows: (i) 42,000 on the first date on which the average trading price of the Company's Class A common stock is at or above $12.00 per share for the preceding 30 consecutive trading days, and (ii) 42,000 on the first date on which the average trading price of the Company's Class A common stock is at or above $16.00 per share for the preceding 30 consecutive trading days, all subject to the terms of the Plan and an award agreement under the Plan.
- F3These stock-settled stock appreciation rights were previously granted under the Plan and will vest (either wholly or partially) based on the extent to which certain financial performance targets established by the Company's Board of Directors are achieved for the 2016 fiscal year.
- F4These stock-settled stock appreciation rights were previously granted under the Issuer's Long-Term Incentive Plan and are scheduled to vest in increments of 20%, 20%, 20%, and 40% on successive anniversary dates of the grant, subject to the terms of the plan and an award agreement under the plan.
- F5These stock-settled stock appreciation rights were previously granted under the Issuer's Long-Term Incentive Plan (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.
Remarks
* HealthPocket, Inc. is a subsidiary of Issuer.