SEC Form 4 · accession 0001567619-19-000354
Health Insurance Innovations, Inc. · HIIQ
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Michael D Hershberger
Officer — CFO, Secretary and Treasurer
Period of report
Jan 2, 2019
Accepted (ET)
Jan 3, 2019 · 5:19 pm EST
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 | Jan 2, 2019 | F | 6,000 | $26.16 | D | 99,151 | D | |
| Class A Common Stock | Aug 16, 2018 | G | 9,972 | $0.00 | D | 89,179 | 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 | $10.45 | holding | — | — | — | — | May 21, 2021 | Common Stock | 10,000 | 10,000 | D |
| Stock Appreciation RightsF3 | $4.95 | holding | — | — | — | — | Jul 1, 2022 | Common Stock | 15,000 | 15,000 | D |
| Stock Appreciation RightsF3 | $4.99 | holding | — | — | — | — | Sep 16, 2022 | Common Stock | 22,500 | 22,500 | D |
| Stock Appreciation RightsF3 | $5.20 | holding | — | — | — | — | Sep 16, 2023 | Common Stock | 40,972 | 40,972 | D |
Explanation of responses
- F1Represents withholding of shares by Issuer to satisfy tax liability of Reporting Person incident to vesting of restricted stock.
- F2These stock-settled stock appreciation rights were granted under the long Term Incentive Plan of Health Insurance Innovations, Inc. (the "Plan") and vest 20% on the first three anniversaries of grant date and 40% on the fourth anniversary, subject to the terms of the Plan and an award agreement under the Plan.
- F3These stock-settled stock appreciation rights were granted under the Plan and vest 25% on the first and second anniversaries of grant date and 50% on the third anniversary, subject to the terms of the Plan and an award agreement under the Plan.