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
OMB APPROVAL
OMB Number: 3235-0287
Estimated average burden
hours per response: 0.5
X
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*
Fountain T Heath

(Last) (First) (Middle)
721 NORTH WESTOVER BOULEVARD

(Street)
ALBANY GA 31707

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
Heritage Financial Group Inc [ HBOS ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director 10% Owner
X Officer (give title below) Other (specify below)
EVP, Chief Admin. Off., CFO
3. Date of Earliest Transaction (Month/Day/Year)
07/01/2015
4. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
X Form filed by One Reporting Person
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
Common Stock 07/01/2015 D(1)(2) 5,600 D (1)(2) 0 D
Common Stock 07/01/2015 D(1)(2) 100 D (1)(2) 0 I UTMA for son
Common Stock 07/01/2015 D(1)(2) 11,387 D (1)(2) 0 I By 401(k)
Common Stock 07/01/2015 D(1)(2) 8,820 D (1)(2) 0 I By ESOP
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
Stock Option (Right to Buy) $11.94 07/01/2015 D(1)(3) 8,000 (4) 07/01/2021 Common Stock 8,000 $15.06(1)(3)(5) 0 D
Explanation of Responses:
1. Pursuant to the Agreement and Plan of Merger by and among Renasant Corporation ("Renasant"), Renasant Bank ("Renasant Bank"), Heritage Financial Group, Inc. ("Heritage"), and HeritageBank of the South ("HeritageBank"), dated as of December 10, 2014 (the "Merger Agreement"), on July 1, 2015 (the "Effective Date"), Heritage merged with and into Renasant (the "Merger"), with Renasant continuing as the surviving corporation. Immediately following the Merger, HeritageBank merged with and into Renasant Bank, with Renasant Bank continuing as the surviving banking association.
2. Pursuant to the Merger Agreement, on the Effective Date, each outstanding share of Heritage's common stock was converted into the right to receive 0.9266 shares (the "Exchange Ratio") of Renasant common stock. Restricted shares of Heritage common stock outstanding on the Effective Date became fully-vested and were converted into shares of Renasant common stock, adjusted to reflect the Exchange Ratio. Any fractional share due was paid in cash.
3. Pursuant to the Merger Agreement, on the Effective Date, each in-the-money Heritage stock option became fully-vested and was converted into the right to receive a cash payment equal to (a) the total number of shares subject to such stock option multiplied by (b) the difference between $27.00 and the exercise price of the option, less applicable tax withholdings (the "Option Cancellation"). Stock appreciation rights granted in tandem with the Heritage stock options were cancelled in connection with the Option Cancellation for no additional consideration.
4. The options were granted under the Issuer's 2011 Equity Incentive Plan and vest in five equal annual installments beginning on July 1, 2012.
5. Reflects the difference between the exercise price of the option and $27.00.
Remarks:
/s/ T. Heath Fountain 07/01/2015
** 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.