0001567619-19-009138.txt : 20190424 0001567619-19-009138.hdr.sgml : 20190424 20190424181936 ACCESSION NUMBER: 0001567619-19-009138 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20180910 FILED AS OF DATE: 20190424 DATE AS OF CHANGE: 20190424 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: 19764874 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: 19764875 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: 19764876 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 doc1.xml FORM 4 X0306 4 2018-09-10 0 0001561387 Health Insurance Innovations, Inc. HIIQ 0001569146 Kosloske Michael W 15438 N. FLORIDA AVENUE SUITE 201 TAMPA FL 33613 1 0 1 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 2018-09-10 4 G 0 18100 0 D 7979 D Class A Common Stock 2018-09-10 4 G 0 7979 0 D 0 D Class A Common Stock 2019-04-22 4 M 0 106173 9.20 A 106173 D Class A Common Stock 2019-04-22 4 D 0 41871 24.85 D 64302 D Class B Common Stock 2416667 I See Footnote Class A Common Stock 125000 I See Footnote Class A Common Stock 5643 I See Footnote Stock Appreciation Rights 9.80 2019-04-22 4 M 0 106173 0 D 2019-06-07 Common Stock 106173 0 D Stock Appreciation Rights 23.8 2019-06-07 Common Stock 40834 40834 D Membership Int in Health Plan Intermediaries Holdings, LLC 0 Class A Common Stock 125000 2416667 I See Footnote Represents shares previously reported as being held by the Michael W. Kosloske 2012 Descendant's Trust as to which the Reporting Person exercised a power of substitution and subsequently gifted. Represents the exercise of stock appreciation rights prior to the expiration thereof. Shares retained by the issuer to satisfy the exercise price of stock appreciation rights exercised by the Reporting Person. 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 2,391,701 shares of Class B Common Stock held of record by Health Plan Intermediaries, LLC ("HPI") and 24,966 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. This number of shares consists of 123,750 shares of Class A Common Stock held of record by HPI and 1,250 shares of Class A 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 A Common Stock held of record by each of HPI and HPIS. By Lori Kosloske. Michael Kosloske and Lori Kosloske are husband and wife. Share number previously incorrectly reported as 7,203. 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. This number consists of 2,391,701 Class B Membership Interests in HPIH held of record by HPI and 24,966 interests held by HPIS. Michael Kosloske is the sole member and primary manager of HPI, and has sole voting and dispositive power over the interests held by HPI. HPI is the sole managing member of HPIS and has sole voting and dispositive power over the interests 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 Class B Membership Interests of HPIH held of record by each of HPI and HPIS. /s/ Michael W. Kosloske 2019-04-24