Filing Details

Accession Number:
0001140361-15-007416
Form Type:
5
Zero Holdings:
No
Publication Time:
2015-02-17 16:24:33
Reporting Period:
2014-08-20
Filing Date:
2015-02-17
Accepted Time:
2015-02-17 16:24:33
SEC Url:
Form 4 Filing
Issuer
Cik Name Symbol Sector (SIC) IRS No
1561387 Health Insurance Innovations Inc. HIIQ Insurance Agents, Brokers & Service (6411) 461282634
Insiders
Cik Name Reported Address Insider Title Director Officer Large Shareholder Other
1569131 Lori Kosloske 15438 N. Florida Avenue
Suite 201
Tampa FL 33613
Yes No No No
1569146 W Michael Kosloske 15438 N. Florida Avenue
Suite 201
Tampa FL 33613
Chairman, President And Ceo Yes Yes Yes No
1571685 Health Plan Intermediaries Sub, Llc C/O Health Insurance Innovations, Inc.
15438 N. Florida Avenue, Suite 201
Tampa FL 33613
No No Yes No
1571686 Health Plan Intermediaires, Llc C/O Health Insurance Innovations, Inc.
15438 N. Florida Avenue, Suite 201
Tampa FL 33613
No No Yes No
Reported Non-Derivative Transactions
Sec. Name Acquisiton - Disposition Date Amount Price Remaning Holdings Equity Swap Involved Form Type Code Nature of Ownership Explanation
Class A Common Stock Disposition 2014-08-20 1,725,000 $12.15 6,841,667 No 4 S Indirect See Footnote
Class A Common Stock Disposition 2014-03-08 817 $12.40 8,318 No 4 F Indirect See Footnote
Equity Swap Involved Form Type Code Nature of Ownership Explanation
No 4 S Indirect See Footnote
No 4 F Indirect See Footnote
Reported Derivative Transactions
Sec. Name Sec. Type Acquisiton - Disposition Date Amount Price Amount - 2 Price - 2
Class A Common Stock Class B Common Stock Disposition 2014-08-20 1,725,000 $0.00 1,725,000 $0.00
Remaning Holdings Exercise Date Expiration Date Equity Swap Involved Transaction Form Type Transaction Code Nature of Ownership
6,841,667 No 4 C Indirect
Reported Non-Derivative Holdings
Sec. Name Remaning Holdings Nature of Ownership Explanation
Class A Common Stock 100 Direct
Footnotes
  1. This number of shares consists of 6,772,451 shares of Class B Common Stock held of record by Health Plan Intermediaries, LLC ("HPI") and 69,216 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. The shares of Class B Common Stock, together with the Series B Membership Interests of HPI, are exchangeable, at Mr. Kosloske's election, for equal numbers of shares of Class A Common Stock. This exchange right has no expiration date.
  2. By Lori Kosloske. Michael Kosloske and Lori Kosloske are husband and wife. Represents withholding of shares by Issuer to satisfy tax liability incident to vesting of restricted stock.
  3. This exchange has no expiration date.