UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(h) of the Investment Company Act of 1940 |
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | SEC 1473 (7-02) | ||
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 control number. |
1. Title of Derivative Security (Instr. 4) |
2. Date Exercisable and Expiration Date (Month/Day/Year) |
3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) |
4. Conversion or Exercise Price of Derivative Security | 5. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 5) |
6. Nature of Indirect Beneficial Ownership (Instr. 5) |
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Date Exercisable | Expiration Date | Title | Amount or Number of Shares |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
Sykes Andrew C/O INTERSECTIONS INC. 3901 STONECROFT BOULEVARD CHANTILLY, VA 20151 |
 |  |  President, IISI |  |
/s/ Jordan Rosenbaum, Attorney-in-Fact | 03/11/2015 | |
**Signature of Reporting Person | Date |
* | If the form is filed by more than one reporting person, see Instruction 5(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). |
(1) | According to the terms of an asset purchase agreement dated March 5, 2015 (the "Agreement"), pursuant to which Intersections Insurance Services Inc. ("IISI") acquired substantially all of the assets of Health at Work Wellness Actuaries LLC, the Reporting Person may in the future be entitled to receive earn-out payments in the form of shares of common stock during certain time periods subject to the terms and conditions specified in the Agreement. The Reporting Person's right to receive additonal shares pursuant to the earn-out became fixed and irrevocable on March 5, 2015, the effective date of the acquisition. |
 Remarks: Exhibit List Exhibit 24 - Power of Attorney |