SEC Form 4 · accession 0001140361-17-034304
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
Sep 1, 2017
Accepted (ET)
Sep 5, 2017 · 4:16 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 | Sep 1, 2017 | M | 2,000 | $12.13 | A | 19,500 | D | |
| Class A Common StockF3,F4 | Sep 1, 2017 | D | 668 | $36.1885 | D | 18,832 | D | |
| Class A Common StockF4 | Sep 1, 2017 | S | 1,332 | $36.1885 | D | 17,500 | D | |
| Class A Common Stock | Sep 1, 2017 | M | 10,000 | $4.95 | A | 27,500 | D | |
| Class A Common StockF3,F4 | Sep 1, 2017 | D | 1,362 | $36.1885 | D | 26,138 | D | |
| Class A Common StockF4 | Sep 1, 2017 | S | 8,638 | $36.1885 | D | 17,500 | 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 RightsF1 | $12.13 | Sep 1, 2017 | M | 2,000 | D | — | Jul 14, 2021 | Class A Common Stock | 2,000 | 4,000 | D |
| Stock Appreciation RightsF2 | $4.95 | Sep 1, 2017 | M | 10,000 | D | — | Jul 1, 2022 | Class A Common Stock | 10,000 | 20,000 | D |
Explanation of responses
- F1These 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.
- F2These 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.
- F3Shares retained by the issuer to satisfy the exercise price of stock appreciation rights exercised by the reporting person.
- F4The price reported in Column 4 is a weighted average price. The shares were sold in multiple transactions at prices ranging from $36.00 to $36.35, inclusive. The Reporting Person undertakes to provide Health Insurance Innovations Inc. (the "Company"), any security holder of the Company, 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.
Remarks
* HealthPocket, Inc. is a subsidiary of Issuer.