SEC Form 5 · accession 0001619954-16-000050

Inovalon Holdings, Inc. · INOV

Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗

Reporting owner

Andre S Hoffmann

Director · 10% Owner

Period of report

Dec 31, 2015

Accepted (ET)

Feb 9, 2016 · 2:34 pm EST

Rule 10b5-1 plan

unknown — predates the checkbox

Issuer CIK

0001619954

Table I — non-derivative securities

No Table I lines on this filing.

Table II — derivative securities

Security	Conv. / exercise price	Date	Code	Shares	A/D	Exercisable	Expires	Underlying	Underlying shares	Owned after	D/I
Class B Common Stock^F3,F1	—	Oct 19, 2015	J	11,793,388	D	—	—	Class A Common Stock	11,793,388	2,246,360	I
Class B Common Stock^F1	—	Oct 19, 2015	J	11,793,388	A	—	—	Class A Common Stock	11,793,388	16,315,983	D
Class B Common Stock^F1	—	Oct 19, 2015	J	2,648,983	D	—	—	Class A Common Stock	2,648,983	0	I
Class B Common Stock^F1	—	Oct 19, 2015	J	2,648,983	A	—	—	Class A Common Stock	2,648,983	18,964,966	D
Class B Common Stock^F1	—	Oct 19, 2015	J	2,246,360	D	—	—	Class A Common Stock	2,246,360	0	I
Class B Common Stock^F9,F1	—	Oct 19, 2015	J	2,246,360	A	—	—	Class A Common Stock	2,246,360	2,246,360	I

Explanation of responses

F1The Class B Common Stock is convertible into the issuer's Class A Common Stock on a 1-for-1 basis (a) at the holder's option or (b) upon certain transfers of such shares, and has no expiration date.
F2Transfer of shares of Class B Common Stock held by Lapis Ventures SAC Limited on behalf of Lapis Healthcare to Mr. Hoffmann.
F3Shares held by Lapis Ventures SAC Limited on behalf of Lapis Healthcare. Mr. Hoffmann has an indirect pecuniary interest in all of these shares, and his children, who reside with him, have direct pecuniary interests.
F4Receipt of shares of Class B Common Stock transferred by Lapis Ventures SAC Limited on behalf of Lapis Healthcare to Mr. Hoffmann.
F5Transfer of shares of Class B Common Stock held by Lapis Ventures SAC Limited on behalf of Lapis Data to Mr. Hoffmann.
F6Receipt of shares of Class B Common Stock transferred by Lapis Ventures SAC Limited on behalf of Lapis Data to Mr. Hoffmann.
F7Transfer of shares of Class B Common Stock held by Lapis Ventures SAC Limited on behalf of Lapis Healthcare to Lapis Ventures SAC Limited on behalf of Lapis Clinical. Mr. Hoffmann has an indirect pecuniary interest in all of these shares, and his children, who reside with him, have direct pecuniary interests.
F8Receipt of shares of Class B Common Stock transferred by Lapis Ventures SAC Limited on behalf of Lapis Healthcare to Lapis Ventures SAC Limited on behalf of Lapis Clinical. Mr. Hoffmann has an indirect pecuniary interest in all of these shares, and his children, who reside with him, have direct pecuniary interests.
F9Shares held by Lapis Ventures SAC Limited on behalf of Lapis Clinical. Mr. Hoffmann has an indirect pecuniary interest in all of these shares, and his children, who reside with him, have direct pecuniary interests.