0001140361-19-021966.txt : 20191205
0001140361-19-021966.hdr.sgml : 20191205
20191205081956
ACCESSION NUMBER: 0001140361-19-021966
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20191204
FILED AS OF DATE: 20191205
DATE AS OF CHANGE: 20191205
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: 191269494
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: 191269495
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: 191269496
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
2019-12-04
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
2019-12-04
4
S
0
6250
18.8794
D
0
I
See Footnote
Class A Common Stock
5643
I
See Footnote
Class B Common Stock
1916667
I
See Footnote
Represents the weighted average of a range of sale prices from $18.68 to $19.04. 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.
This number of shares consists of shares of Class A Common Stock held of record by Health Plan Intermediaries Sub, LLC ("HPIS"). Michael Kosloske is the sole member and primary manager of Health Plan Intermediaries, LLC ("HPI"), which 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 HPIS.
By Lori Kosloske. Michael Kosloske and Lori Kosloske are husband and wife.
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 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.
/s/ Michael W. Kosloske
2019-12-05