SEC Form 4 · accession 0001140361-17-020803
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.* · Director
Period of report
May 11, 2017
Accepted (ET)
May 15, 2017 · 5:17 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 | May 11, 2017 | M | 5,710 | $6.77 | A | 107,211 | D | |
| Class A Common StockF1 | May 11, 2017 | D | 1,872 | $20.65 | D | 105,339 | D | |
| Class A Common Stock | May 11, 2017 | S | 3,838 | $20.65 | D | 101,501 | D | |
| Class A Common Stock | May 12, 2017 | M | 22,000 | $6.77 | A | 123,501 | D | |
| Class A Common StockF1 | May 12, 2017 | D | 7,093 | $21.8538 | D | 116,408 | D | |
| Class A Common StockF2 | May 12, 2017 | S | 14,907 | $22.2703 | D | 101,501 | 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 RightsF3 | $6.77 | May 11, 2017 | M | 5,710 | D | — | May 25, 2021 | Class A Common Stock | 5,710 | 42,000 | D |
| Stock Appreciation RightsF3 | $6.77 | May 12, 2017 | M | 22,000 | D | — | May 25, 2021 | Class A Common Stock | 22,000 | 20,000 | D |
| Stock Appreciation RightsF4 | $12.13 | holding | — | — | — | — | Jul 14, 2021 | Class A Common Stock | 6,000 | 6,000 | D |
| Stock Appreciation RightsF5 | $4.95 | holding | — | — | — | — | Jul 1, 2022 | Class A Common Stock | 30,000 | 30,000 | D |
Explanation of responses
- F1Shares retained by the issuer to satisfy the exercise price of stock appreciation rights exercised by the reporting person.
- F2The price in Column 4 is a weighted average price. The prices actually received ranged from $22.22 to 22.375. 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.
- F3These stock-settled stock appreciation rights were granted under the Issuer's Long-Term Incentive Plan (the "Plan") and became vested as follows: (i) 42,000 on the first date on which the average trading price of the Company's Class A common stock was 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 was 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.
- F4These stock-settled stock appreciation rights were previously granted under the 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 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.