0001209191-22-001213.txt : 20220104 0001209191-22-001213.hdr.sgml : 20220104 20220104210434 ACCESSION NUMBER: 0001209191-22-001213 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20211230 FILED AS OF DATE: 20220104 DATE AS OF CHANGE: 20220104 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: RAINA ROBIN CENTRAL INDEX KEY: 0001244876 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-15946 FILM NUMBER: 22508591 MAIL ADDRESS: STREET 1: 5 CONCOURSE PARKWAY S 3200 CITY: ATLANTA STATE: GA ZIP: 30328 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: EBIX INC CENTRAL INDEX KEY: 0000814549 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-COMPUTER INTEGRATED SYSTEMS DESIGN [7373] IRS NUMBER: 770021975 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 1 EBIX WAY CITY: JOHNS CREEK STATE: GA ZIP: 30097 BUSINESS PHONE: 678-281-2020 MAIL ADDRESS: STREET 1: 1 EBIX WAY CITY: JOHNS CREEK STATE: GA ZIP: 30097 FORMER COMPANY: FORMER CONFORMED NAME: EBIX COM INC DATE OF NAME CHANGE: 19991115 FORMER COMPANY: FORMER CONFORMED NAME: DELPHI INFORMATION SYSTEMS INC /DE/ DATE OF NAME CHANGE: 19920703 4 1 doc4.xml FORM 4 SUBMISSION X0306 4 2021-12-30 0 0000814549 EBIX INC EBIX 0001244876 RAINA ROBIN 1 EBIX WAY JOHNS CREEK GA 30097 1 1 1 0 Chairman & CEO Common Stock 2021-12-30 4 F 0 40000 30.44 D 4092140 D Common Stock 217064 I The Robin Raina Foundation The above shares of common stock are being forfeited exclusively to assist with the payment of the reporting person's tax obligations. These shares of common stock were not sold as part of an open market trade but rather were part of an adjustment process by the Issuer with the shares of common stock being retired by the Issuer. This number has been revised to include 200,000 shares of restricted stock that were granted in July 2020, but were inadvertently reported in Table II at the time of grant. /s/ Robin Raina 2022-01-04