SEC Form 4 · accession 0001140361-17-025361
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
Jun 14, 2017
Accepted (ET)
Jun 16, 2017 · 4:23 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 | Jun 14, 2017 | A | 17,500 | $0.00 | A | 119,001 | 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 | $12.13 | holding | — | — | — | — | Jul 14, 2021 | Class A Common Stock | 6,000 | 6,000 | D |
| Stock Appreciation RightsF3 | $4.95 | holding | — | — | — | — | Jul 1, 2022 | Class A Common Stock | 30,000 | 30,000 | D |
Explanation of responses
- F1These restricted shares were granted under the Issuer's Long Term Incentive Plan, as amended ("Plan"), and are scheduled to vest 25% on each of the first four anniversaries of the grant date, subject to the terms and conditions of the Plan and a Restricted Stock Award Agreement under the Plan.
- F2These 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.
- F3These 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.