0001209191-14-059969.txt : 20140926 0001209191-14-059969.hdr.sgml : 20140926 20140926163021 ACCESSION NUMBER: 0001209191-14-059969 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20140924 FILED AS OF DATE: 20140926 DATE AS OF CHANGE: 20140926 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 BUSINESS ADDRESS: STREET 1: 2600 MCCORMICK DRIVE STREET 2: SUITE 300 CITY: CLEARWATER STATE: FL ZIP: 33759 BUSINESS PHONE: 7273627202 MAIL ADDRESS: STREET 1: 2600 MCCORMICK DRIVE STREET 2: SUITE 300 CITY: CLEARWATER STATE: FL ZIP: 33759 FORMER COMPANY: FORMER CONFORMED NAME: Heritage Insurance Holdings, LLC DATE OF NAME CHANGE: 20140130 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Lucas Bruce CENTRAL INDEX KEY: 0001552968 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-36462 FILM NUMBER: 141124345 MAIL ADDRESS: STREET 1: 2109 E. PALM AVENUE CITY: TAMPA STATE: FL ZIP: 33605 4 1 doc4.xml FORM 4 SUBMISSION X0306 4 2014-09-24 0 0001598665 Heritage Insurance Holdings, Inc. HRTG 0001552968 Lucas Bruce C/O HERITAGE INSURANCE HOLDINGS, INC. 2600 MCCORMICK DRIVE SUITE 300 CLEARWATER FL 33759 1 1 0 0 Chairman & CEO Common Stock 117055 D Common Stock 540600 D Common Stock 22418 I See Footnote Common Stock 318750 I See Footnote Common Stock 582682 I See Footnote Stock Option (Right to Buy) 14.02 2014-09-24 4 A 0 100000 0.00 A 2015-03-15 2017-09-24 Common Stock 100000 100000 D Shares of common stock reported on this line are held by Mr. Lucas and his wife as tenants by the entirety. Shares of common stock reported on this line are held by Mr. Lucas' wife. Shares of common stock reported on this line are held by IIM Holdings, LLC and IIM Holdings II, LLC, entities controlled by Mr. Lucas. Shares of common stock reported on this line are held by the Bruce Lucas Irrevocable Grantor Retained Annuity Trust of 2014. /s/ Bruce Lucas 2014-09-26