0001567619-19-021560.txt : 20191114
0001567619-19-021560.hdr.sgml : 20191114
20191114161115
ACCESSION NUMBER: 0001567619-19-021560
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20191112
FILED AS OF DATE: 20191114
DATE AS OF CHANGE: 20191114
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Hershberger Michael D
CENTRAL INDEX KEY: 0001569128
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-35811
FILM NUMBER: 191220218
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
2019-11-12
0
0001561387
Health Insurance Innovations, Inc.
HIIQ
0001569128
Hershberger Michael D
C/O HEALTH INSURANCE INNOVATIONS, INC.
15438 NORTH FLORIDA AVE., SUITE 201
TAMPA
FL
33613
0
1
0
0
CFO, Secretary and Treasurer
Class A Common Stock
2019-11-12
4
D
0
16500
0
D
39198
D
Stock Appreciation Rights
10.45
2021-05-21
Common Stock
10000
10000
D
Stock Appr;eciation Rights
4.95
2022-07-01
Common Stock
15000
15000
D
Stock Appreciation Rights
4.99
2022-09-16
Common Stock
22500
22500
D
Stock Appreciation Rights
5.20
2023-09-16
Common Stock
40972
40972
D
Represents forfeiture of restricted shares pursuant to Separation Agreement.
These stock-settled stock appreciation rights were granted on May 21, 2014 under the Long Term Incentive Plan of Health Insurance Innovations, Inc. (the "Plan") and are all vested.
These stock-settled stock appreciation rights were granted on July 1, 2015 under the Plan and are all vested.
These stock-settled stock appreciation rights were granted on September 16, 2015 under the Plan and are all vested.
These stock-settled stock appreciation rights were granted on September 16, 2016 under the Plan and are all vested.
/s/ Michael D. Hershberger
2019-11-14