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
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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*
Hyer Raymond T

(Last) (First) (Middle)
3919 E 7TH AVENUE

(Street)
TAMPA FL 33605

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
Heritage Insurance Holdings, Inc. [ HRTG ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director X 10% Owner
Officer (give title below) Other (specify below)
3. Date of Earliest Transaction (Month/Day/Year)
11/10/2022
4. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
Form filed by One Reporting Person
X 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 11/10/2022 P 158,660 A $1.33(1) 2,478,655(2) D
COMMON STOCK 11/11/2022 P 130,000 A $1.41(3) 2,608.655(4) D
COMMON STOCK 100,000(5) D
COMMON STOCK 50,000(6) D
COMMON STOCK 22,000(7) D
COMMON STOCK 460,000(8) I see footnote
COMMON STOCK 120,000(9) I see footnote
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
1. Name and Address of Reporting Person*
Hyer Raymond T

(Last) (First) (Middle)
3919 E 7TH AVENUE

(Street)
TAMPA FL 33605

(City) (State) (Zip)

Relationship of Reporting Person(s) to Issuer
Director X 10% Owner
Officer (give title below) Other (specify below)
1. Name and Address of Reporting Person*
HYER KATHLEEN A

(Last) (First) (Middle)
3919 E 7TH AVENUE

(Street)
TAMPA FL 33605

(City) (State) (Zip)

Relationship of Reporting Person(s) to Issuer
Director 10% Owner
Officer (give title below) X Other (specify below)
Member of 10% owner group
1. Name and Address of Reporting Person*
TIRA TARA K

(Last) (First) (Middle)
3919 E 7TH AVENUE

(Street)
TAMPA FL 33605

(City) (State) (Zip)

Relationship of Reporting Person(s) to Issuer
Director 10% Owner
Officer (give title below) X Other (specify below)
Member of 10% owner group
1. Name and Address of Reporting Person*
POOLE SEAN W

(Last) (First) (Middle)
3919 E 7TH AVE

(Street)
TAMPA FL 33605

(City) (State) (Zip)

Relationship of Reporting Person(s) to Issuer
Director 10% Owner
Officer (give title below) X Other (specify below)
Member of 10% owner group
1. Name and Address of Reporting Person*
FUTURA CIRCUITS CORP.

(Last) (First) (Middle)
3919 E 7TH AVE

(Street)
TAMPA FL 33605

(City) (State) (Zip)

Relationship of Reporting Person(s) to Issuer
Director 10% Owner
Officer (give title below) X Other (specify below)
Member of 10% owner group
1. Name and Address of Reporting Person*
HYER FAMILY PARTNERSHIP, LLC

(Last) (First) (Middle)
3919 E 7TH AVE

(Street)
TAMPA FL 33605

(City) (State) (Zip)

Relationship of Reporting Person(s) to Issuer
Director 10% Owner
Officer (give title below) X Other (specify below)
Member of 10% owner group
Explanation of Responses:
1. The price reported in column 4 is a weighted average price. The shares were purchased in multiple transactions at prices ranging from $1.20 to $1.39, inclusive. The reporting person undertakes to provide to the issuer, any security holder of the issuer, or the staff of the Securities and Exchange Commission, upon request, full information regarding the number of shares sold at each separate price within the ranges set forth in this footnote.
2. 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.
3. The price reported in column 4 is a weighted average price. The shares were purchased in multiple transactions at prices ranging from $1.37 to $1.45, inclusive. The reporting person undertakes to provide to the issuer, any security holder of the issuer, or the staff of the Securities and Exchange Commission, upon request, full information regarding the number of shares sold at each separate price within the ranges set forth in this footnote.
4. 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.
5. These securities are owned solely by Kathleen Hyer. Raymond T. Hyer may be deemed to have a pecuniary interest in these securities.
6. These securities are owned solely by Tara Tira.
7. These securities are owned solely by Sean W. Poole.
8. These securities are held of record by Futura Circuits Corp., which is 100% owned by Raymond T. Hyer.
9. These securities are held of record by Hyer Family Partnership, LLC, which is approx. 29% owned by Raymond T. Hyer, with the remainder owned by other individuals, including Tara Tira and Sean W. Poole. Each disclaims beneficial ownership except to the extent of their pecuniary interest in these securities.
/s/ Raymond T. Hyer 11/14/2022
/s/ Kathleen A. Hyer, by Raymond T. Hyer as attorney-in fact 11/14/2022
/s/ Tara K. Tira, by Raymond T. Hyer as attorney-in fact 11/14/2022
/s/ Sean W. Poole, by Raymond T. Hyer as attorney-in fact 11/14/2022
/s/ Raymond T. Hyer (P of Futura Circuits 11/14/2022
/s/ Sean Poole, (Mgr of HFP), by Raymond T. Hyer as attorney-in fact 11/14/2022
** 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.
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