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