0001140361-17-012162.txt : 20170315 0001140361-17-012162.hdr.sgml : 20170315 20170315175512 ACCESSION NUMBER: 0001140361-17-012162 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20170313 FILED AS OF DATE: 20170315 DATE AS OF CHANGE: 20170315 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: Kosloske Michael W CENTRAL INDEX KEY: 0001569146 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-35811 FILM NUMBER: 17692313 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 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: 17692314 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: 17692315 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: 17692316 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 2017-03-13 0 0001561387 Health Insurance Innovations, Inc. HIIQ 0001569146 Kosloske Michael W 15438 N. FLORIDA AVENUE SUITE 201 TAMPA FL 33613 1 1 1 0 Chief of Product Innovation 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 100 D Class A Common Stock 7203 I See Footnote Class A Common Stock 26079 I See Footnote Class A Common Stock 2017-03-13 4 S 0 3000000 13.16 D 3841667 I See Footnote Stock Appreciation Rights 9.8 2023-11-19 Common Stock 106173 106173 D By Lori Kosloske. Michael Kosloske and Lori Kosloske are husband and wife. By Michael W. Kosloske 2012 Descendants Trust Agreement dated December 7, 2012, Lori Kosloske as Directing Trustee. This number of shares consists of 3,802,451 shares of Class B Common Stock held of record by Health Plan Intermediaries, LLC ("HPI") and 39,216 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. These stock-settled stock appreciation rights were granted to Michael Kosloske under the Issuer's Long-Term Incentive Plan and vest 25% on each of the first and second anniversaries of grant date (11/19/2016) and 50% on the third anniversary, subject to the terms of the Long-Term Incentive Plan and an award agreement under the Long-Term Incentive Plan. /s/ Michael Hershberger, as Attorney-in-Fact 2017-03-14