Initial Statement of Beneficial Ownership (3)
August 12 2022 - 4:08PM
Edgar (US Regulatory)
FORM 3
|
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES
|
OMB APPROVAL
OMB Number:
3235-0104
Estimated average burden hours per response...
0.5
|
|
Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 or Section 30(h) of the Investment Company Act of 1940
|
|
1. Name and Address of Reporting Person
*
Hyer Raymond T |
2. Date of Event Requiring Statement (MM/DD/YYYY)
8/2/2022
|
3. Issuer Name and Ticker or Trading Symbol
Heritage Insurance Holdings, Inc. [HRTG]
|
(Last)
(First)
(Middle)
3919 E 7TH AVENUE |
4. Relationship of Reporting Person(s) to Issuer (Check all applicable)
_____ Director ___X___ 10% Owner _____ Officer (give title below) _____ Other (specify below)
|
(Street)
TAMPA, FL 33605
(City)
(State)
(Zip)
| 5. If Amendment, Date Original Filed(MM/DD/YYYY)
| 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 Beneficially Owned
|
1.Title of Security (Instr. 4) | 2. Amount of Securities Beneficially Owned (Instr. 4) | 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) | 4. Nature of Indirect Beneficial Ownership (Instr. 5) |
COMMON STOCK | 2090000 (1) | D | |
COMMON STOCK | 100000 (2) | D | |
COMMON STOCK | 50000 (3) | D | |
COMMON STOCK | 22000 (4) | D | |
COMMON STOCK | 460000 (5) | I | (SEE FOOTNOTE) |
COMMON STOCK | 120000 (6) | I | (SEE FOOTNOTE) |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
|
1. Title of Derivate Security (Instr. 4) | 2. Date Exercisable and Expiration Date (MM/DD/YYYY) | 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) |
Date Exercisable | Expiration Date | Title | Amount or Number of Shares |
Explanation of Responses: |
(1) | These securities are owned solely by Raymond T. Hyer, who is a member of a group with the other Reporting Persons for purposes of Section 13(d) of the Exchange Act. |
(2) | These securities are owned solely by Kathleen Hyer. Raymond T. Hyer may be deemed to have a pecuniary interest in these securities. |
(3) | These securities are owned solely by Tara Tira. |
(4) | These securities are owned solely by Sean W. Poole. |
(5) | These securities are held of record by Futura Circuits Corp., which is 100% owned by Raymond T. Hyer. |
(6) | These securities are held of record by Hyer Family Partnership, LLC, which is approx. 29% owned by Raymond T. Hyer, with the remainder owned by other individuals, including Tara Tira and Sean W. Poole. Each disclaims beneficial ownership except to the extent of their pecuniary interest in these securities. |
Reporting Owners
|
Reporting Owner Name / Address | Relationships |
Director | 10% Owner | Officer | Other |
Hyer Raymond T 3919 E 7TH AVENUE TAMPA, FL 33605 |
| X |
|
|
HYER KATHLEEN A 3919 E 7TH AVENUE TAMPA, FL 33605 |
|
|
| Member of 10% owner group |
TIRA TARA K 3919 E 7TH AVENUE TAMPA, FL 33605 |
|
|
| Member of 10% owner group |
POOLE SEAN W 3919 E 7TH AVE TAMPA, FL 33605 |
|
|
| Member of 10% owner group |
FUTURA CIRCUITS CORP. 3919 E 7TH AVE TAMPA, FL 33605 |
|
|
| Member of 10% owner group |
HYER FAMILY PARTNERSHIP, LLC 3919 E 7TH AVE TAMPA, FL 33605 |
|
|
| Member of 10% owner group |
Signatures
|
/s/ Raymond T. Hyer | | 8/11/2022 |
**Signature of Reporting Person | Date |
/s/ Kathleen A. Hyer | | 8/11/2022 |
**Signature of Reporting Person | Date |
/s/ Tara Tira | | 8/11/2022 |
**Signature of Reporting Person | Date |
/s/ Sean W. Poole | | 8/11/2022 |
**Signature of Reporting Person | Date |
/s/ Raymond T. Hyer o/b/o Futura Circuits Corp. | | 8/11/2022 |
**Signature of Reporting Person | Date |
/s/ Sean Poole o/b/o Hyer Family Partnerhsip, LLC | | 8/11/2022 |
**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 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). |
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 control number. |
Heritage Insurance (NYSE:HRTG)
Historical Stock Chart
From Aug 2024 to Sep 2024
Heritage Insurance (NYSE:HRTG)
Historical Stock Chart
From Sep 2023 to Sep 2024