SEC FORM 4 SEC Form 4
FORM 4 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP

Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934
or Section 30(h) of the Investment Company Act of 1940
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Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
1. Name and Address of Reporting Person*
Kosloske Michael W

(Last) (First) (Middle)
15438 N. FLORIDA AVENUE, SUITE 201

(Street)
TAMPA FL 33613

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
Health Insurance Innovations, Inc. [ HIIQ ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director X 10% Owner
X Officer (give title below) Other (specify below)
CEO and Director
3. Date of Earliest Transaction (Month/Day/Year)
03/08/2013
4. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
Form filed by One Reporting Person
X Form filed by More than One Reporting Person
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
1. Title of Security (Instr. 3) 2. Transaction Date (Month/Day/Year) 2A. Deemed Execution Date, if any (Month/Day/Year) 3. Transaction Code (Instr. 8) 4. Securities Acquired (A) or Disposed Of (D) (Instr. 3, 4 and 5) 5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4) 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 7. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V Amount (A) or (D) Price
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 3) 2. Conversion or Exercise Price of Derivative Security 3. Transaction Date (Month/Day/Year) 3A. Deemed Execution Date, if any (Month/Day/Year) 4. Transaction Code (Instr. 8) 5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) 6. Date Exercisable and Expiration Date (Month/Day/Year) 7. Title and Amount of Securities Underlying Derivative Security (Instr. 3 and 4) 8. Price of Derivative Security (Instr. 5) 9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) 10. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 11. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V (A) (D) Date Exercisable Expiration Date Title Amount or Number of Shares
Class B Common Stock (2) 03/08/2013 S 100,000 (2) (3) Class A Common Stock 0 $14(1) 8,566,667 I(2)(3) See footnotes(2)(3)
1. Name and Address of Reporting Person*
Kosloske Michael W

(Last) (First) (Middle)
15438 N. FLORIDA AVENUE, SUITE 201

(Street)
TAMPA FL 33613

(City) (State) (Zip)
1. Name and Address of Reporting Person*
Kosloske Lori

(Last) (First) (Middle)
15438 N. FLORIDA AVENUE, SUITE 201

(Street)
TAMPA FL 33613

(City) (State) (Zip)
1. Name and Address of Reporting Person*
Health Plan Intermediaires, LLC

(Last) (First) (Middle)
15438 N. FLORIDA AVENUE, SUITE 201

(Street)
TAMPA FL 33613

(City) (State) (Zip)
1. Name and Address of Reporting Person*
Health Plan Intermediaries Sub, LLC

(Last) (First) (Middle)
15438 N. FLORIDA AVENUE, SUITE 201

(Street)
TAMPA FL 33613

(City) (State) (Zip)
Explanation of Responses:
1. The reported price is the price to the public in the primary offering before underwriting discounts, fees and expenses.
2. This number of shares consists of 8,480,000 shares of Class B common stock held of record by Health Plan Intermediaries, LLC ("HPI") and 86,667 shares of Class B common stock held by Health Plan Intermediaries Sub, LLC ("HPIS"). The Reporting Person 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. The Reporting Person, 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 the Reporting Person's election, for equal number of shares of Class A common stock, representing, in the aggregate, 65% of the shares of Class A common stock outstanding following such exchange.
3. This exchange right has no expiration date.
Remarks:
/s/ Joan Rodgers, as Attorney-in-Fact 03/12/2013
** Signature of Reporting Person Date
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
* If the form is filed by more than one reporting person, see Instruction 4 (b)(v).
** Intentional misstatements or omissions of facts constitute Federal Criminal Violations See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure.
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number.
Unassociated Document

 
Exhibit 99.1
 
Joint Filer Information
 

Name of Joint Filer:
 
Lori Kosloske*
Address of Joint Filer:
15438 N. Florida Avenue, Suite 201
Tampa, Florida 33613
 
Designated Filer:
 
Michael W. Kosloske
Relationship of Joint Filer to Issuer:
 
Issuer & Ticker Symbol:
 
Officer (Chief Compliance Officer)
 
Health Insurance Innovations, Inc. [HHIQ]
Date of Earliest Transaction Required to be Reported
3/8/2013
 
Signature:
/s/                                      
Name:  Lori Kosloske
Title:  Chief Compliance Officer
*Lori Kosloske is the spouse of Michael W. Kosloske.
 

Name of Joint Filer:
 
Health Plan Intermediaries, LLC
Address of Joint Filer:
15438 N. Florida Avenue, Suite 201
Tampa, Florida 33613
 
Designated Filer:
 
Michael W. Kosloske
Relationship of Joint Filer to Issuer:
 
Issuer & Ticker Symbol:
 
Michael W. Kosloske is the sole member and primary manager of Health Plan Intermediaries, LLC, and has sole voting and dispositive power over the shares held by Health Plan Intermediaries, LLC.
 
Health Insurance Innovations, Inc. [HIIQ]
 
Date of Earliest Transaction Required to be Reported
3/8/2013
 

Name of Joint Filer:
 
Health Plan Intermediaries Sub, LLC
Address of Joint Filer:
15438 N. Florida Avenue, Suite 201
Tampa, Florida 33613
 
Designated Filer:
 
Michael W. Kosloske
Relationship of Joint Filer to Issuer:
 
Issuer & Ticker Symbol:
 
Health Plan Intermediaries, LLC is the sole managing member of Health Plan Intermediaries Sub, LLC and has sole voting and dispositive power over the shares held by Health Plan Intermediaries Sub, LLC.
 
Health Insurance Innovations, Inc. [HIIQ]
 
Date of Earliest Transaction Required to be Reported
3/8/2013