0001672048-24-000001.txt : 20240221 0001672048-24-000001.hdr.sgml : 20240221 20240221160946 ACCESSION NUMBER: 0001672048-24-000001 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20231219 FILED AS OF DATE: 20240221 DATE AS OF CHANGE: 20240221 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: HYER FAMILY PARTNERSHIP, LLC CENTRAL INDEX KEY: 0001930029 ORGANIZATION NAME: STATE OF INCORPORATION: FL FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-36462 FILM NUMBER: 24659501 BUSINESS ADDRESS: STREET 1: 3919 E 7TH AVE CITY: TAMPA STATE: FL ZIP: 33605 BUSINESS PHONE: 813 503 8483 MAIL ADDRESS: STREET 1: 3919 E 7TH AVE CITY: TAMPA STATE: FL ZIP: 33605 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Hyer Raymond T CENTRAL INDEX KEY: 0001672048 ORGANIZATION NAME: FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-36462 FILM NUMBER: 24659506 MAIL ADDRESS: STREET 1: 3919 E 7TH AVENUE CITY: TAMPA STATE: FL ZIP: 33605 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: FUTURA CIRCUITS CORP. CENTRAL INDEX KEY: 0001929927 ORGANIZATION NAME: STATE OF INCORPORATION: FL FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-36462 FILM NUMBER: 24659502 BUSINESS ADDRESS: STREET 1: 3919 E 7TH AVE CITY: TAMPA STATE: FL ZIP: 33605 BUSINESS PHONE: 630 920 8833 MAIL ADDRESS: STREET 1: 3919 E 7TH AVE CITY: TAMPA STATE: FL ZIP: 33605 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: POOLE SEAN W CENTRAL INDEX KEY: 0001942239 ORGANIZATION NAME: FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-36462 FILM NUMBER: 24659503 MAIL ADDRESS: STREET 1: 3919 E 7TH AVE CITY: TAMPA STATE: FL ZIP: 33605 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: HYER KATHLEEN A CENTRAL INDEX KEY: 0001930038 ORGANIZATION NAME: FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-36462 FILM NUMBER: 24659505 MAIL ADDRESS: STREET 1: 3919 E 7TH AVENUE CITY: TAMPA STATE: FL ZIP: 33605 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: TIRA TARA K CENTRAL INDEX KEY: 0001930289 ORGANIZATION NAME: FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-36462 FILM NUMBER: 24659504 MAIL ADDRESS: STREET 1: 3919 E 7TH AVENUE CITY: TAMPA STATE: FL ZIP: 33605 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Heritage Insurance Holdings, Inc. CENTRAL INDEX KEY: 0001598665 STANDARD INDUSTRIAL CLASSIFICATION: FIRE, MARINE & CASUALTY INSURANCE [6331] ORGANIZATION NAME: 02 Finance 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 1 primary_doc.xml PRIMARY DOCUMENT X0508 4 2023-12-19 0 0001598665 Heritage Insurance Holdings, Inc. HRTG 0001672048 Hyer Raymond T 3919 E 7TH AVENUE TAMPA FL 33605 0 0 1 0 0001930038 HYER KATHLEEN A 3919 E 7TH AVENUE TAMPA FL 33605 0 0 0 1 MEMBER OF GROUP 0001930289 TIRA TARA K 3919 E 7TH AVENUE TAMPA FL 33605 0 0 0 1 MEMBER OF GROUP 0001942239 POOLE SEAN W 3919 E 7TH AVE TAMPA FL 33605 0 0 0 1 MEMBER OF GROUP 0001929927 FUTURA CIRCUITS CORP. 3919 E 7TH AVE TAMPA FL 33605 0 0 0 1 MEMBER OF GROUP 0001930029 HYER FAMILY PARTNERSHIP, LLC 3919 E 7TH AVE TAMPA FL 33605 0 0 0 1 MEMBER OF GROUP 0 COMMON STOCK 2023-12-19 4 P 0 148148 6.75 A 2959263 D COMMON STOCK 100000 D COMMON STOCK 50000 D COMMON STOCK 22000 D COMMON STOCK 460000 I See Footnote COMMON STOCK 120000 I See Footnote 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. These securities are owned solely by The Kathleen Hyer Revocable Trust. These securities are owned solely by Tara Tira. These securities are owned solely by Sean W. Poole. These securities are owned solely by Futura Circuits Corp. These securities are owned solely by Hyer Family Partnership, LLC. /s/ Raymond T. Hyer 2024-02-20 /s/ Kathleen Hyer Revocable Trust, by Raymond T. Hyer as Co-Trustee 2024-02-20 Tara K. Tira 2024-02-20 /s/ Sean W. Poole 2024-02-20 /s/ Raymond T. Hyer (P of Futura Circuits Corp.) 2024-02-20 /s/ Sean Poole, Manager of Hyer Family Partnership, LLC 2024-02-20