0000899243-22-024166.txt : 20220627 0000899243-22-024166.hdr.sgml : 20220627 20220627132106 ACCESSION NUMBER: 0000899243-22-024166 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20220623 FILED AS OF DATE: 20220627 DATE AS OF CHANGE: 20220627 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Berset Mark S CENTRAL INDEX KEY: 0001439853 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-36462 FILM NUMBER: 221043385 MAIL ADDRESS: STREET 1: 1050 FRIENDLY WAY SOUTH CITY: SAINT PETERSBURG STATE: FL ZIP: 33705 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 1 doc4.xml FORM 4 SUBMISSION X0306 4 2022-06-23 0 0001598665 Heritage Insurance Holdings, Inc. HRTG 0001439853 Berset Mark S C/O HERITAGE INSURANCE HOLDINGS, INC. 2600 MCCORMICK DRIVE SUITE 300 CLEARWATER FL 33759 1 0 0 0 Common Stock 2022-06-23 4 A 0 12422 0.00 A 259343 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 grant date and (ii) the day immediately prior to the date of the annual meeting of the stockholders of the issuer that next follows the grant date. 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 Mark Berset 2012 Irrevocable Trust for the benefit of the Reporting Person's children. The Reporting Person 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 2022-06-27