0001140361-15-012137.txt : 20150317
0001140361-15-012137.hdr.sgml : 20150317
20150317101117
ACCESSION NUMBER: 0001140361-15-012137
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20150308
FILED AS OF DATE: 20150317
DATE AS OF CHANGE: 20150317
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: Health Insurance Innovations, Inc.
CENTRAL INDEX KEY: 0001561387
STANDARD INDUSTRIAL CLASSIFICATION: INSURANCE AGENTS BROKERS & SERVICES [6411]
IRS NUMBER: 461282634
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 15438 N. FLORIDA AVENUE
STREET 2: SUITE 201
CITY: TAMPA
STATE: FL
ZIP: 33613
BUSINESS PHONE: 813-280-1289
MAIL ADDRESS:
STREET 1: 15438 N. FLORIDA AVENUE
STREET 2: SUITE 201
CITY: TAMPA
STATE: FL
ZIP: 33613
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Health Plan Intermediaries Sub, LLC
CENTRAL INDEX KEY: 0001571685
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-35811
FILM NUMBER: 15705098
BUSINESS ADDRESS:
STREET 1: C/O HEALTH INSURANCE INNOVATIONS, INC.
STREET 2: 15438 N. FLORIDA AVENUE, SUITE 201
CITY: TAMPA
STATE: FL
ZIP: 33613
BUSINESS PHONE: (877) 376-5831
MAIL ADDRESS:
STREET 1: C/O HEALTH INSURANCE INNOVATIONS, INC.
STREET 2: 15438 N. FLORIDA AVENUE, SUITE 201
CITY: TAMPA
STATE: FL
ZIP: 33613
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Health Plan Intermediaires, LLC
CENTRAL INDEX KEY: 0001571686
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-35811
FILM NUMBER: 15705099
BUSINESS ADDRESS:
STREET 1: C/O HEALTH INSURANCE INNOVATIONS, INC.
STREET 2: 15438 N. FLORIDA AVENUE, SUITE 201
CITY: TAMPA
STATE: FL
ZIP: 33613
BUSINESS PHONE: (877) 376-5831
MAIL ADDRESS:
STREET 1: C/O HEALTH INSURANCE INNOVATIONS, INC.
STREET 2: 15438 N. FLORIDA AVENUE, SUITE 201
CITY: TAMPA
STATE: FL
ZIP: 33613
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Kosloske Lori
CENTRAL INDEX KEY: 0001569131
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-35811
FILM NUMBER: 15705100
MAIL ADDRESS:
STREET 1: C/O HEALTH INSURANCE INNOVATIONS, INC.
STREET 2: 15438 N. FLORIDA AVENUE, SUITE 201
CITY: TAMPA
STATE: FL
ZIP: 33613
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Kosloske Michael W
CENTRAL INDEX KEY: 0001569146
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-35811
FILM NUMBER: 15705101
MAIL ADDRESS:
STREET 1: C/O HEALTH INSURANCE INNOVATIONS, INC.
STREET 2: 15438 N. FLORIDA AVENUE, SUITE 201
CITY: TAMPA
STATE: FL
ZIP: 33613
4
1
doc1.xml
FORM 4
X0306
4
2015-03-08
0
0001561387
Health Insurance Innovations, Inc.
HIIQ
0001569146
Kosloske Michael W
15438 N. FLORIDA AVENUE
SUITE 201
TAMPA
FL
33613
1
1
1
0
Chairman, President and CEO
0001569131
Kosloske Lori
15438 N. FLORIDA AVENUE
SUITE 201
TAMPA
FL
33613
1
0
0
0
0001571686
Health Plan Intermediaires, LLC
C/O HEALTH INSURANCE INNOVATIONS, INC.
15438 N. FLORIDA AVENUE, SUITE 201
TAMPA
FL
33613
0
0
1
0
0001571685
Health Plan Intermediaries Sub, LLC
C/O HEALTH INSURANCE INNOVATIONS, INC.
15438 N. FLORIDA AVENUE, SUITE 201
TAMPA
FL
33613
0
0
1
0
Class A Common Stock
2015-03-08
4
F
0
582
7.44
D
7736
I
See Footnote
Class A Common Stock
100
D
Class A Common Stock
6841667
I
See Footnote
Represents withholding of shares by Issuer to satisfy tax liability incident to vesting of restricted stock.
By Lori Kosloske. Michael Kosloske and Lori Kosloske are husband and wife.
This number of shares consists of 6,772,451 shares of Class B Common Stock held of record by Health Plan Intermediaries, LLC ("HPI") and 69,216 shares of Class B Common Stock held by Health Plan Intermediaries Sub, LLC ("HPIS"). Michael Kosloske is the sole member and primary manager of HPI, and has sole voting and dispositive power over the shares held by HPI. HPI is the sole managing member of HPIS and has sole voting and dispositive power over the shares held by HPIS. Mr. Kosloske, by virtue of his control of HPI and HPI's control of HPIS, may be deemed to beneficially own all the shares of Class B Common Stock held of record by each of HPI and HPIS. The shares of Class B Common Stock, together with the Series B Membership Interests of HPI, are exchangeable, at Mr. Kosloske's election, for equal numbers of shares of Class A Common Stock. This exchange right has no expiration date.
/s/ Joan Rodgers, as Attorney-in-Fact
2015-03-16