0001140361-17-043406.txt : 20171120 0001140361-17-043406.hdr.sgml : 20171120 20171120173506 ACCESSION NUMBER: 0001140361-17-043406 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20171116 FILED AS OF DATE: 20171120 DATE AS OF CHANGE: 20171120 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: 171214875 MAIL ADDRESS: STREET 1: C/O HEALTH INSURANCE INNOVATIONS, INC. STREET 2: 15438 N. FLORIDA AVENUE, SUITE 201 CITY: TAMPA STATE: FL ZIP: 33613 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: 813-397-1187 MAIL ADDRESS: STREET 1: 15438 N. FLORIDA AVENUE STREET 2: SUITE 201 CITY: TAMPA STATE: FL ZIP: 33613 4 1 doc1.xml FORM 4 X0306 4 2017-11-16 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 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 3841667 I See Footnote Stock Appreciation Rights 23.80 2017-11-16 4 A 0 40834 0 A 2024-11-16 Common Stock 40834 40834 D 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 the Reporting Person under the Issuer's Long-Term Incentive Plan and vest 25% on each of the first and second anniversaries of grant date 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. These stock-settled stock appreciation rights were granted to the Reporting Person under the Issuer's Long-Term Incentive Plan and vest 25% on each of the first and second anniversaries of grant date 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 2017-11-20