0001140361-19-012413.txt : 20190703 0001140361-19-012413.hdr.sgml : 20190703 20190703133855 ACCESSION NUMBER: 0001140361-19-012413 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20190701 FILED AS OF DATE: 20190703 DATE AS OF CHANGE: 20190703 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: 19941072 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: 19941073 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 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: 19941074 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 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 form4.xml FORM 4 X0306 4 2019-07-01 0001561387 Health Insurance Innovations, Inc. HIIQ 0001569146 Kosloske Michael W 16221 VILLARREAL DE AVILA TAMPA FL 33613 true 0001571686 Health Plan Intermediaires, LLC C/O HEALTH INSURANCE INNOVATIONS, INC. 15438 N. FLORIDA AVENUE, SUITE 201 TAMPA FL 33613 true 0001571685 Health Plan Intermediaries Sub, LLC C/O HEALTH INSURANCE INNOVATIONS, INC. 15438 N. FLORIDA AVENUE, SUITE 201 TAMPA FL 33613 true Class A Common Stock 2019-07-01 4 S 0 37650 26.1746 D 14760 I See Footnote Class A Common Stock 2019-07-01 4 S 0 13510 26.7193 D 1250 I See Footnote Class B Common Stock 2019-07-03 4 J 0 500000 0 D 1916667 I See Footnote Class A Common Stock 2019-07-03 4 J 0 500000 0 A 498046 I See Footnote Class A Common Stock 320 D Class A Common Stock 5643 I See Footnote Membership Int in Health Plan Intermediaries Holdings, LLC 0 2019-07-03 4 J 0 500000 0 D Class A Common Stock 500000 1916667 I See footnote Represents the weighted average of a range of sale prices from $25.51 to $26.50. The reporting person undertakes to provide to the Staff of the Securities and Exchange Commission, the Company or any stockholder of the Company, upon request, full information regarding the number of shares sold at each separate price. Reflects the anticipated exchange of 3,204 shares of Class B Common Stock held of record by HPI (as defined in note 3) for an equal number of shares of Class A Common Stock. Each share of Class B Common Stock held by the reporting persons, together with one Series B Membership Interest held by the reporting persons in Health Plan Intermediaries Holdings, LLC ("HPIH"), are together exchangeable, at any time, at the reporting persons' election, for one share of Class A Common Stock. This exchange right has no expiration date. This number of shares consists of shares of Class A Common Stock held of record by Health Plan Intermediaries, LLC ("HPI") and Health Plan Intermediaries Sub, LLC ("HPIS"). HPIS owns 1,250 of such shares and the remainder are held by HPI. 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 A Common Stock held of record by each of HPI and HPIS. Represents the weighted average of a range of sale prices from $26.51 to $27.05. The reporting person undertakes to provide to the Staff of the Securities and Exchange Commission, the Company or any stockholder of the Company, upon request, full information regarding the number of shares sold at each separate price. Each share of Class B Common Stock held by the reporting persons, together with one Series B Membership Interest held by the reporting persons in Health Plan Intermediaries Holdings, LLC ("HPIH"), are together exchangeable, at any time, at the reporting persons' election, for one share of Class A Common Stock. This exchange right has no expiration date. Reflects the exchange of shares of Class B Common Stock, together with an equal number of Series B Membership Interests of HPIH, into shares of Class A Common Stock pursuant to the Exchange Agreement, dated February 13, 2013, between the reporting persons and issuer. This number of shares consists of 1,896,701 shares of Class B Common Stock held of record by HPI and 19,966 shares of Class B Common Stock held by 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. This number of shares consists of shares of Class A Common Stock held of record by HPI and HPIS. HPIS owns 6,250 of such shares and the remainder are held by HPI. 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 A Common Stock held of record by each of HPI and HPIS. By Lori Kosloske. Michael Kosloske and Lori Kosloske are husband and wife. This number consists of 1,896,701 Class B Membership Interests in HPIH held of record by HPI and 19,966 interests held by HPIS. /s/ Michael W. Kosloske 2019-07-03