0000899243-23-018039.txt : 20230811
0000899243-23-018039.hdr.sgml : 20230811
20230811150722
ACCESSION NUMBER: 0000899243-23-018039
CONFORMED SUBMISSION TYPE: 4/A
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20230619
FILED AS OF DATE: 20230811
DATE AS OF CHANGE: 20230811
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Berset Mark S
CENTRAL INDEX KEY: 0001439853
FILING VALUES:
FORM TYPE: 4/A
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-36462
FILM NUMBER: 231163504
MAIL ADDRESS:
STREET 1: 700 CENTRAL AVE
CITY: SAINT PETERSBURG
STATE: FL
ZIP: 33701
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: Heritage Insurance Holdings, Inc.
CENTRAL INDEX KEY: 0001598665
STANDARD INDUSTRIAL CLASSIFICATION: FIRE, MARINE & CASUALTY INSURANCE [6331]
IRS NUMBER: 455338504
STATE OF INCORPORATION: DE
BUSINESS ADDRESS:
STREET 1: 1401 N WESTSHORE BLVD
CITY: TAMPA
STATE: FL
ZIP: 33607
BUSINESS PHONE: 7273627202
MAIL ADDRESS:
STREET 1: 1401 N WESTSHORE BLVD
CITY: TAMPA
STATE: FL
ZIP: 33607
FORMER COMPANY:
FORMER CONFORMED NAME: Heritage Insurance Holdings, LLC
DATE OF NAME CHANGE: 20140130
4/A
1
doc4a.xml
FORM 4/A SUBMISSION
X0508
4/A
2023-06-19
2023-06-21
0
0001598665
Heritage Insurance Holdings, Inc.
HRTG
0001439853
Berset Mark S
C/O HERITAGE INSURANCE HOLDINGS, INC.
1401 N. WESTSHORE BLVD
TAMPA
FL
33607
1
0
0
0
0
Common Stock
2023-06-19
4
A
0
9662
0.00
A
269005
D
Common Stock
47000
I
By IRA
Common Stock
36700
I
By Trust
Common Stock
316400
I
By Trust
Common Stock
84909
I
By Trust
These shares were issued as a restricted stock grant to the Reporting Person by the Issuer. The restricted stock shall vest on the earlier of (i) the one-year anniversary of the date of issuance and (ii) the day immediately prior to the date of the following year's annual meeting of stockholders of the Issuer.
This amendment is being filed solely to correct a typographical error in the number of shares of restricted stock awarded.
These securities are held by the Linda Berset IRA. The Reporting Person disclaims beneficial ownership of these securities except to the extent of his pecuniary interest therein and this report shall not be deemed an admission that the Reporting Person is the beneficial owner of such securities for purposes of Section 16 or for any other purpose.
These securities are held by the Linda Berset Irrevocable Trust. The Reporting Person's spouse is the trustee of the trust. The Reporting Person disclaims beneficial ownership of these securities except to the extent of his pecuniary interest therein and this report shall not be deemed an admission that the Reporting Person is the beneficial owner of such securities for purposes of Section 16 or for any other purpose.
These securities are held by the Linda Berset Irrevocable Trust. The Reporting Person's spouse is the trustee of the trust. The Reporting Person disclaims beneficial ownership of these securities except to the extent of his pecuniary interest therein and this report shall not be deemed an admission that the Reporting Person is the beneficial owner of such securities for purposes of Section 16 or for any other purpose.
These securities are held by the Linda C Berset Family Trust. The Reporting Person and his spouse are co-trustees of the trust. The Reporting Person disclaims beneficial ownerhip of these securities except to the extent of his pecuniary interest therein and this report shall not be deemed an admission that the Reproting Person is the beneficial owner of such seucities for purposes of Section 16 or for any other purpose.
/s/ Mark S. Berset
2023-08-11