SEC Form 4 · accession 0001140361-17-028189
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
Jul 17, 2017
Accepted (ET)
Jul 19, 2017 · 4:20 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 StockF2 | Jul 17, 2017 | S | 15,000 | $26.50 | D | 104,001 | D | |
| Class A Common StockF3 | Jul 18, 2017 | S | 15,000 | $26.86 | D | 89,001 | 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 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
- F1The sales reported in this Form 4 were effected pursuant to a Rule 10b5-1 trading plan adopted by the Reporting Person on March 9, 2017.
- F2The price reported in Column 4 is a weighted average price. The shares were sold in multiple transactions at prices ranging from $25.80 to $26.75, inclusive. The Reporting Person undertakes to provide Health Insurance Innovations Inc., any security holder of Health Insurance Innovations Inc., or the staff of the Securities & Exchange Commission, upon request, full information regarding the number of shares sold at each separate price within the range set forth herein.
- F3The price reported in Column 4 is a weighted average price. The shares were sold in multiple transactions at prices ranging from $27.25 to $26.40, inclusive. The Reporting Person undertakes to provide Health Insurance Innovations Inc., any security holder of Health Insurance Innovations Inc., or the staff of the Securities & Exchange Commission, upon request, full information regarding the number of shares sold at each separate price within the range set forth herein.
- F4These stock-settled stock appreciation rights were previously granted under the Issuer's Long Term Incentive Plan, as amended ("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.