0001140361-15-033436.txt : 20150825
0001140361-15-033436.hdr.sgml : 20150825
20150825172602
ACCESSION NUMBER: 0001140361-15-033436
CONFORMED SUBMISSION TYPE: 4/A
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20150814
FILED AS OF DATE: 20150825
DATE AS OF CHANGE: 20150825
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/A
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-35811
FILM NUMBER: 151074047
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/A
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-35811
FILM NUMBER: 151074048
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/A
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-35811
FILM NUMBER: 151074049
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/A
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-35811
FILM NUMBER: 151074050
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/A
1
doc1.xml
FORM 4/A
X0306
4/A
2015-08-14
2015-04-18
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
2015-08-14
4
P
0
3740
4.4277
A
3740
I
See Footnote
Class A Common Stock
2015-08-17
4
P
0
22339
4.8191
A
26079
I
See Footnote
This Amended Form 4 is being filed solely for the purpose of adding a footnote to this transaction to explain that the price is a weighted average price. This footnote was erroneously omitted on the Form 4 filed August 18, 2015.
These shares were purchased at a range of prices from $4.40 to $4.49. The reporting person will provide upon request by the Commission staff, the issuer, or a security holder of the issuer, full information regarding the number of shares purchased at each separate price.
By Michael W. Kosloske 2012 Descendants Trust Agreement dated December 7, 2012, Lori Kosloske as Directing Trustee.
These shares were purchased at a range of prices from $4.53 to $4.98. The reporting person will provide upon request by the Commission staff, the issuer, or a security holder of the issuer, full information regarding the number of shares purchased at each separate price.
/s/ Michael W. Kosloske
2015-08-20