SEC Form 4 · accession 0001140361-17-023091
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
May 26, 2017
Accepted (ET)
May 31, 2017 · 4:19 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 26, 2017 | M | 5,570 | $6.77 | A | 107,071 | D | |
| Class A Common StockF1 | May 26, 2017 | D | 1,669 | $22.60 | D | 105,402 | D | |
| Class A Common Stock | May 26, 2017 | S | 3,901 | $22.60 | 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 RightsF2 | $6.77 | May 26, 2017 | M | 5,570 | D | — | May 25, 2021 | Class A Common Stock | 5,570 | 11,442 | D |
| Stock Appreciation RightsF3 | $12.13 | holding | — | — | — | — | Jul 14, 2021 | Class A Common Stock | 6,000 | 6,000 | D |
| Stock Appreciation RightsF4 | $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.
- F2These stock-settled stock appreciation rights were granted under the Issuer's Long-Term Incentive Plan (the "Plan") and are all currently vested.
- F3These 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.
- F4These 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.