Document:

Form of Class A common stock Certificate

 Exhibit 4.1 

 

	
	

	 NUMBER
 HII
 Health Insurance Innovations

SHARES
 INCORPORATED UNDER THE LAWS OF THE STATE OF DELAWARE

CUSIP
 SEE REVERSE FOR CERTAIN DEFINITIONS
 This Certifies
that
 is the owner of
 FULLY PAID AND NONASSESSABLE SHARES OF CLASS A COMMON STOCK, $0.001 PAR VALUE PER SHARE, OF HEALTH INSURANCE INNOVATIONS, INC. transferable on the books of the Corporation by the holder
hereof in person or by duly authorized attorney upon surrender of this certificate properly endorsed. This certificate and the shares represented hereby are subject to the laws of the State of Delaware, and to the Certificate of Incorporation and
Bylaws of the Corporation, as now in effect or as hereafter amended. This certificate is not valid until countersigned and registered by the Transfer Agent and Registrar.
 WITNESS the facsimile seal of the Corporation and the facsimile signatures of its duly authorized officers.
 CERTIFICATE OF STOCK
 Dated:

TREASURER
 Health Insurance Innovations, Inc.

CORPORATE
 SEAL
 2012

DELAWARE
 PRESIDENT
 © SECURITY-COLUMBIAN UNITED STATES
BANKNOTE COMPANY 1960
 COUNTERSIGNED AND REGISTERED:

AMERICAN STOCK TRANSFER & TRUST COMPANY, LLC
 (Brooklyn, N.Y.)
 TRANSFER AGENT AND
REGISTRAR
 BY
 AUTHORIZED SIGNATURE
 ABnote North
America
 711 ARMSTRONG LANE
 COLUMBIA, TENNESSEE 38401
 (931)
388-3003
 HOLLY GRONER 931-490-7660
 PROOF OF: JANUARY 14, 2013
 HEALTH INSURANCE
INNOVATIONS
 WO- 6416 FACE
 OPERATOR: MR REV.1
 Colors Selected for Printing:
Intaglio prints in PMS 2767. logo prints in PMS 202 Red and PMS 2767 Blue
 COLOR: This proof was printed from a
digital file or artwork on a graphics quality, color laser printer. It is a good representation of the color as it will appear on the final product.
 However, it is not an exact color rendition, and the final printed product may appear slightly different from the proof due to the difference between the dyes and printing ink.

NOTE: TEXT RECEIVED BY MODEM OR E-MAIL IS NOT PROOFREAD WORD FOR WORD.

PLEASE INITIAL THE APPROPRIATE SELECTION FOR THIS PROOF: OK AS IS OK WITH CHANGES MAKE CHANGES AND SEND ANOTHER
PROOF

 THE CORPORATION WILL FURNISH TO ANY STOCKHOLDER, UPON REQUEST AND WITHOUT CHARGE, A FULL
STATEMENT OF THE DESIGNATIONS, RELATIVE RIGHTS, PREFERENCES AND LIMITATIONS OF THE SHARES OF EACH CLASS AND SERIES AUTHORIZED TO BE ISSUED, SO FAR AS THE SAME HAVE BEEN DETERMINED, AND OF THE AUTHORITY, IF ANY, OF THE BOARD TO DIVIDE THE SHARES INTO
CLASSES OR SERIES AND TO DETERMINE AND CHANGE THE RELATIVE RIGHTS, PREFERENCES AND LIMITATIONS OF ANY CLASS OR SERIES. 
 The
following abbreviations, when used in the inscription on the face of this certificate, shall be construed as though they were written out in full according to applicable laws or regulations: 

 

															
	TEN COM  	 	—	 	  as tenants in common	 	UNIF GIFT MIN ACT —	 	  
	 	Custodian	 	  

	TEN ENT	 	—	 	  as tenants by the entireties	 		 	(Cust)	 		 	(Minor)
	JT TEN	 	—	 	  as joint tenants with right	 		 	under Uniform Gifts to Minors

											
		 		 	of survivorship and not as	 		 	Act	 	  

		 		 	tenants in common	 		 		 	(State)

 Additional abbreviations may also be used though not in the above list. 

For value received,
                                        
hereby sell, assign and transfer unto 
  

			
	 PLEASE INSERT SOCIAL SECURITY OR OTHER

IDENTIFYING NUMBER OF ASSIGNEE
	  	
	 	
	 	  	 

  
  

PLEASE PRINT OR TYPE NAME AND ADDRESS INCLUDING ZIP CODE OF ASSIGNEE 

 
  
  

 
  

			
	  
	 	Shares

  

			
	of the stock represented by the within Certificate, and do hereby irrevocably constitute and 
appoint	 	  

  

			
	  
	 	Attorney

 to transfer the said stock on the books of the within named Corporation with full power of substitution in the premises.

  

			
	Dated	 	  

  

					
		 		 	  

		 	NOTICE:	 	THE SIGNATURE(S) TO THIS ASSIGNMENT MUST CORRESPOND WITH THE NAME(S) AS WRITTEN UPON THE FACE OF THE CERTIFICATE IN EVERY PARTICULAR, WITHOUT ALTERATION OR ENLARGEMENT OR ANY CHANGE
WHATSOEVER.

  

			
	Signature(s) Guaranteed:	 	
		
	  
	 	
	THE SIGNATURE(S) MUST BE GUARANTEED BY AN ELIGIBLE GUARANTOR INSTITUTION (BANKS, STOCKBROKERS, SAVINGS AND LOAN ASSOCIATIONS AND CREDIT UNIONS WITH MEMBERSHIP IN AN APPROVED
SIGNATURE GUARANTEE MEDALLION PROGRAM), PURSUANT TO S.E.C. RULE 17Ad-15.Commitment Letter

 Exhibit 10.23 

 

					
	SunTrust Bank	 		  	Jordan Young, Senior Vice President
	Mail Code Fl Tampa 4105	 		  	Relationship Manager
	P.O. Box 3303	 		  	
	Tampa, FL 33602	 		  	
	Tel 813 318-3436	 		  	
	Fax 813 224-2424	 		  	

  
 

 
 COMMITMENT LETTER 
 January 24, 2013 
 Health Plan Intermediaries Holdings, LLC 

The Michael W. Kosloske 2012 Descendants Trust Agreement 
 15438 North Florida Avenue 
 Suite 201 
 Tampa, Fl. 33613 
 Attention: Michael W. Kosloske, Member & CEO, Health Plan
Intermediaries Holdings, LLC ; and; Lori Kosloske, Trustee, The Michael W. Kosloske 2012 Descendants Trust Agreement 
 Re: $2,000,000 revolving
line of credit to Health Plan Intermediaries Holdings, LLC (“HPIH”) and to The Michael W. Kosloske 2012 Descendants Trust Agreement (“Descendants Trust”) 
 Mr. Kosloske: 
 SunTrust Bank (the “Bank”) is pleased to
confirm to you that, subject to the terms and conditions set forth in this letter and the terms attached hereto as Annex 1 (the “Term Sheet” and together with this letter, this “Commitment Letter”), the Bank will
establish a $2,000,000 revolving line of credit (the “Facility”) for Health Plan Intermediaries Holdings, LLC, a Delaware corporation (“HPIH”) and for The Michael W. Kosloske 2012 Descendants Trust (“Descendants
Trust”) (collectively the “Borrower”). In addition to those terms set forth in the Term Sheet, the Bank may require certain other customary terms and conditions found in a credit facility of this type which may not be
specifically listed therein. This Commitment Letter replaces and supersedes prior Commitment Letters to HPIH dated December 7, 2012; December 10, 2012; and December 20, 2012 in their entirety. 

This commitment is subject to: (i) the preparation, execution and delivery of mutually acceptable loan documentation, including
note(s) incorporating substantially the terms and conditions set forth in the Term Sheet; (ii) the absence of a material adverse change in the business, condition (financial or otherwise), results of operations or properties of the Borrower
HPIH and its subsidiaries (if any) as reflected in its financial statements as of September 30, 2012; (iii) the accuracy of all representations which you have made or will make to the Bank and all information that you furnish to us and
your compliance with the terms of this Commitment Letter; (iv) a closing of the Facility on or before March 1, 2013; (v) payment of a $10,000 due diligence fee on or before 

 Health Plan Intermediaries Holdings, LLC 
 The Michael W. Kosloske 2012 Descendants Trust Agreement 
 January 24, 2013 

 Page
 2
 
  

 January 28, 2013; and (vi) Borrower HPIH agreeing to maintain its primary operating accounts
at the Bank for a minimum twelve month period commencing with the date of this Commitment Letter. 
 The Borrower hereby agrees
to pay, or reimburse the Bank on demand for, all reasonable costs and expenses incurred by the Bank (whether before or after the date hereof) in connection with this Commitment Letter and the transactions contemplated hereunder (regardless of
whether any of the transactions contemplated hereby are consummated), including without limitation the reasonable costs and expenses of the Bank’s counsel (including in-house counsel), and all reasonable costs and expenses of the Bank,
including, without limitation, reasonable costs and expenses of the Bank’s counsel (including in-house counsel), incurred in connection with the enforcement of its rights and remedies hereunder. Your obligation in respect of such costs and
expenses shall survive the expiration or termination of this Commitment Letter. 
 This Commitment Letter shall constitute a
binding obligation of the Bank for all purposes immediately upon the acceptance hereof by the Borrower in the manner provided herein. Notwithstanding any other provision of this Commitment Letter, the Bank’s commitments and undertakings as set
forth herein shall not be or become effective for any purpose unless and until this Commitment Letter shall have been accepted by the Borrower in the manner specified below. 
 If you are in agreement with the foregoing, please sign and return the enclosed copy of this Commitment Letter to the Bank at its office located at 401 East Jackson Street, Tampa, Fl. 33602 Attention:
Jordan Young. Unless the Bank receives such copy of this Commitment Letter duly executed by an authorized officer of HPIH and by the Trustee of the Descendants Trust prior to 5:00p.m. (EST), Monday, January 28, 2013, along with payment of the
$10,000 due diligence fee by that same time and date, the Bank’s obligations hereunder shall terminate on such date. In no event shall the Bank have any obligation to make the Facility available unless the closing shall have occurred on or
prior to March 1, 2013. In addition to the foregoing, this Commitment Letter may be terminated at any time by mutual agreement. 
 This Commitment Letter is solely for the benefit of the Borrower and the Bank, and no provision hereof shall be deemed to confer rights on any other person or entity. This Commitment Letter may not be
assigned by the Borrower to any other person or entity, but the obligations of the Borrower hereunder shall be binding upon the successors of the Borrower. 
 THIS COMMITMENT LETTER WILL BE GOVERNED BY AND CONSTRUED IN ACCORDANCE WITH THE LAWS OF THE STATE OF FLORIDA WITHOUT REGARD TO THE PRINCIPLES OF CONFLICTS OF LAWS THEREOF. 

 Health Plan Intermediaries Holdings, LLC 
 The Michael W. Kosloske 2012 Descendants Trust Agreement 
 January 24, 2013 

 Page
 3
 
  

 TO THE EXTENT PERMITTED BY APPLICABLE LAW, EACH OF THE BORROWER AND THE BANK HEREBY
WAIVES JURY TRIAL IN ANY ACTION OR PROCEEDING ARISING OUT OF OR RELATED TO THIS COMMITMENT LETTER OR ANY OTHER DOCUMENTS CONTEMPLATED HEREBY. 
 This Commitment Letter may be executed in any number of separate counterparts, each of which shall collectively and separately, constitute one agreement. Upon acceptance by you as provided herein, this
Commitment Letter shall supersede all understandings and agreements between the parties hereto in respect of the transactions contemplated hereby. 
 We look forward to working with you on this transaction. 
  

			
	Very truly yours,
	
	SUNTRUST BANK
		
	By:	 	 /s/ Jordan Young

	Name:	 	Jordan Young
	Title:	 	Senior Vice President

  

			
	Accepted and agreed this      day
	of January, 2013.
	
	Health Plan Intermediaries Holdings, LLC
		
	By:	 	  

	Name:	 	Michael W. Kosloske
	Title:	 	Member and CEO
	
	The Michael W. Kosloske 2012 Descendants Trust Agreement
		
	By:	 	  

	Name:	 	Lori Kosloske
	Title:	 	Trustee

 ANNEX I 

SUMMARY OF TERMS AND CONDITIONS 
  

			
		
	Borrower:	  	Health Plan Intermediaries Holdings, LLC (“HPIH”) and The Michael W. Kosloske 2012 Descendants Trust Agreement (“Descendants Trust”) (collectively the
“Borrower”)
		
	Lender:	  	SunTrust Bank (the “Bank”)
		
	Guarantor(s):	  	The unlimited, unconditional, joint and several personal guarantees of: Michael W. Kosloske and Lori A. Kosloske; the unconditional guaranty of Health Plan Intermediaries, LLC;
and the unconditional guaranty of The Michael W. Kosloske 2012 GRAT Agreement (“2012 GRAT”) (collectively the “Guarantors”, and together with the Borrower, the “Obligors”).
		
	Facility:	  	364-day revolving line of credit on a closed-end basis (the “Facility”)
		
	Loan Amount:	  	$2,000,000.00
		
	Purpose:	  	To finance costs associated with a planned initial public offering and to fund advance commission payments to insurance agents and insurance agencies distributing Borrower’s
short term health insurance policies.
		
	Maturity Date:	  	364 days from the Date of Closing
		
	Interest Rate:	  	The “Index” shall be Bloomberg 30 day LIBOR. The “Rate” shall equal the Index plus 3.50% p. a.
		
	Commitment Fee:	  	$40,000.00 (2% of Loan Amount), due and payable at closing. The $10,000 due diligence fee charged for the Bank’s extension of this January 24, 2013 Commitment letter shall
be credited towards that Commitment Fee at closing, reducing it to $30,000.
		
	Interest Payments:	  	Interest shall be calculated on the basis of a 360-day year and shall be payable on the 1st day of each month, with all accrued interest due and payable on the Maturity Date.
		
	Repayments:	  	The outstanding unpaid principal on all advances shall be due and payable on the Maturity Date
		
	Clean-up Requirement:	  	No clean-up period (annual reduction to $0 principal balance) required.

			
		
	Deposits:	  	The Borrower HPIH shall maintain its primary deposit accounts with The Bank for the greater of the two following periods; either a period of 12 months commencing with the
January 24, 2013 date of this Commitment letter or a period equaling the term of the Facility.
		
	Collateral:	  	 Second lien position UCC filing on all of Borrower’s Business Assets behind SunTrust Bank’s existing first lien on all
Business Assets.
  
 Further pledge of all Units in Health Plan
Intermediaries, LLC owned by Michael W. Kosloske to also include this Facility.
  
 Further assignment of $4,500,000 life insurance policy on Michael W. Kosloske to also include this Facility.

		
	Representations and Warranties:	  	Usual and customary for the Bank in transactions of this type
		
	Affirmative Covenants:	  	Usual and customary for Bank in transactions of this type
		
		  	 •       Annual CPA Audited Financial Statements of the Borrower HPIH due within 150
days of Borrower’s 12/31/xx Fiscal Year Ends.

		
		  	 •       Quarterly internally prepared Financial Statements of the Borrower HPIH, due
within 45 days of each calendar quarter end.

		
		  	 •       Annual Tax Returns of the Corporate Guarantor, Health Plan Intermediaries,
LLC, due within 15 days of completion annually.

		
		  	 •       Annual Personal Tax Returns of the Personal Guarantors Michael W. Kosloske and
Lori A. Kosloske, due within 15 days of completion annually.

		
		  	 •       Annual Personal Financial Statements of the Personal Guarantors Michael W.
Kosloske and Lori A. Kosloske, due annually on or before July 30th or more frequently upon Bank’s request.

		
		  	 •       Copies of Annual Tax Returns for Borrower Descendants Trust and for Guarantor
2012 GRAT, due within 15 days of completion annually if separate Tax Returns are filed for those two trusts.

		
		  	 •       Any other item (s) that is (are) usual and customary for Bank in the
transactions of this type.

		
	Negative Covenants:	  	Minimum Net Worth Covenant. Borrower HPIH shall maintain a minimum net worth of $6,250,000 through the period ending 3/30/2013. Commencing with the quarter ending
3/31/2013, Borrower HPIH will be required to both increase and maintain that minimum net worth figure by an additional $300,000 per quarter.

			
		
		  	For example, from 3/3112013 through 6/29/2013, Borrower HPIH shall be required to have and maintain a minimum net worth figure of $6,550,000. From 6/30/2013 through 9/29/2013
Borrower HPIH shall be required to have and maintain a minimum net worth figure of $6,850,000. These quarterly increases in Borrower HPIH’ s minimum net worth will be required on an ongoing basis for the full term of the
Facility.
		
		  	This Minimum Net Worth Covenant shall be tested quarterly based on Borrower HPIH’s Fiscal Year End Audited Financial Statements and its quarterly internally prepared
financial statements.
		
	Other Negative Covenants:	  	  
 Usual and customary of Bank in transactions of this type,
including limitations on dividend payments if an event of default exists.

		
	Events of Default:	  	Usual and customary for Bank in transactions of this type, including without limitation: (i) failure to pay principal when due; failure to pay any amount owed under the loan
documents, (ii) breach of any covenants, (iii) the breach of any representation or warranty, (iv) cross-default to any other agreement in connection with the Facility and any other indebtedness to the Bank (including any hedging agreement executed
with the Bank), (v) failure to pay any amount owed to any creditor other than Bank under a written agreement calling for payment of money, (vi) bankruptcy or insolvency (whether voluntary or involuntary) of any Obligor, (vii) death, declaration of
incompetency, dissolution, liquidation, merger, consolidation, termination or suspension of business of any Obligor; (viii) a change in control affecting Borrower, defined as a ten percent ( 10%) or greater change in the current ownership of
Borrower without prior Bank consent; (ix) a material change in Borrower’s senior management team without prior Bank consent; (x) a determination by Bank of the occurrence of a material adverse change in the financial condition of any Obligor,
(xi) if secured, any material impairment or deterioration of the value of any collateral; (xii) the sale of all or substantially all of the assets of any Obligor other than in the ordinary course of business; (xiii) continued compliance with all
applicable government regulations by any Obligor; (xiv) any other act or circumstance that makes Bank insecure.
		
	Conditions Precedent:	  	The making of the initial loan will be subject to the following conditions: (i) the execution and delivery of definitive loan documentation acceptable to the Bank and the
Borrower; (ii) the delivery of certified copies of organizational documents (including bylaws), authorizing resolutions of board of directors, and incumbency certificate for the Borrower; (iii) the delivery of good standing certificates issued by
the secretary of state of the jurisdiction of incorporation of the Borrower and each other jurisdiction in which the Borrower is qualified to do business; and (iv) no material adverse change in

			
		
		  	the business, results of operations, properties or financial condition of the Borrower or of the Borrower and its Subsidiaries taken as a whole since the information presented in
Borrower’s internally prepared financial statements for its quarter ending September 30, 2012.
		
		  	The making of each loan shall be subject to accuracy of representations and warranties as of the date of such loan and no event of default or incipient default under the
facilities described herein shall have occurred and be continuing as of the date of such loan or would result from the making of such loan.
		
	Expenses and Indemnification:	  	  
 The Borrower will pay all reasonable costs and expenses of the
Bank (including, without limitation, the reasonable fees, charges and disbursements of the Bank’s counsel (including in-house counsel)) in connection with the preparation, administration and enforcement of all documentation executed in
connection with the Facility.

		
	Governing Law and Jurisdiction:	  	State of Florida

 This Summary of Terms is intended as an outline of certain material terms of the two facilities described herein and
does not purport to describe all of the terms and conditions, representations and warranties, covenants and other provisions that could be contained in the definitive loan documentation relating to the Facility.

Source: [{"source": "alea-institute/alea-institute/kl3m-data-edgar-agreements/train-00211-of-00352.parquet"}, [{"source": "alea-institute/alea-institute/kl3m-data-edgar-agreements/train-00211-of-00352.parquet"}]]