# EDGAR Filing Document

**Accession Number:** 0001930038
**File Stem:** 0001193805-23-000230
**Filing Date:** 2023-2
**Character Count:** 14063
**Document Hash:** 7643fc9136aaf57c5f782e7c902089f5
**Contains OCR:** False
**Source Format:** 

## Filing Content

## Filing Summary
**0001193805-23-000230.hdr.sgml**: 20230215

**ACCESSION NUMBER**: 0001193805-23-000230

**CONFORMED SUBMISSION TYPE**: 4

**PUBLIC DOCUMENT COUNT**: 1

**CONFORMED PERIOD OF REPORT**: 20230213

**FILED AS OF DATE**: 20230215

**DATE AS OF CHANGE**: 20230215

**REPORTING-OWNER**: 

**OWNER DATA:**
- **COMPANY CONFORMED NAME:** HYER FAMILY PARTNERSHIP, LLC
- **CENTRAL INDEX KEY:** 0001930029
- **STATE OF INCORPORATION:** FL
- **FISCAL YEAR END:** 1231

**FILING VALUES:**
- **FORM TYPE:** 4
- **SEC ACT:** 1934 Act
- **SEC FILE NUMBER:** 001-36462
- **FILM NUMBER:** 23636129

**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

**FILING VALUES:**
- **FORM TYPE:** 4
- **SEC ACT:** 1934 Act
- **SEC FILE NUMBER:** 001-36462
- **FILM NUMBER:** 23636134

**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
- **STATE OF INCORPORATION:** FL
- **FISCAL YEAR END:** 1231

**FILING VALUES:**
- **FORM TYPE:** 4
- **SEC ACT:** 1934 Act
- **SEC FILE NUMBER:** 001-36462
- **FILM NUMBER:** 23636130

**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

**FILING VALUES:**
- **FORM TYPE:** 4
- **SEC ACT:** 1934 Act
- **SEC FILE NUMBER:** 001-36462
- **FILM NUMBER:** 23636131

**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

**FILING VALUES:**
- **FORM TYPE:** 4
- **SEC ACT:** 1934 Act
- **SEC FILE NUMBER:** 001-36462
- **FILM NUMBER:** 23636133

**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

**FILING VALUES:**
- **FORM TYPE:** 4
- **SEC ACT:** 1934 Act
- **SEC FILE NUMBER:** 001-36462
- **FILM NUMBER:** 23636132

**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]
- **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

### UNITED STATES SECURITIES AND EXCHANGE COMMISSION
**Washington, D.C. 20549**

## FORM 4

### STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP

[ ] Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).

[ ] Check this box to indicate that a transaction was made pursuant to a contract, instruction or written plan for the purchase or sale of equity securities of the issuer that is intended to satisfy the affirmative defense conditions of Rule 10b5-1(c). See Instruction 10.

---

| | | |
|:---|:---|:---|
| **1. Name and Address of Reporting Person**<sup>*</sup><br>Hyer Raymond T<br><sub>(Last) (First) (Middle)</sub><br>3919 E 7TH AVENUE<br><sub>(Street)</sub><br>TAMPA, FL 33605<br><sub>(City) (State) (Zip)</sub> | **3. Date of Earliest Transaction (Month/Day/Year)**<br>2023-02-13 | **5. Relationship of Reporting Person(s) to Issuer**<br>(Check all applicable)<br>[ ] Director [X] 10% Owner<br>[ ] Officer (give title below) [ ] Other (specify below)<br>_ _ |
| **2. Issuer Name and Ticker or Trading Symbol**<br>Heritage Insurance Holdings, Inc. [ HRTG ] | **4. If Amendment, Date of Original Filed (Month/Day/Year)**<br>  | **6. Individual or Joint/Group Filing (Check Applicable Line)**<br>[ ] Form filed by One Reporting Person<br>[X] Form filed by More than One Reporting Person |

---

---

| | | |
|:---|:---|:---|
| **1. Name and Address of Reporting Person**<sup>*</sup><br>HYER KATHLEEN A<br><sub>(Last) (First) (Middle)</sub><br>3919 E 7TH AVENUE<br><sub>(Street)</sub><br>TAMPA, FL 33605<br><sub>(City) (State) (Zip)</sub> | **3. Date of Earliest Transaction (Month/Day/Year)**<br>2023-02-13 | **5. Relationship of Reporting Person(s) to Issuer**<br>(Check all applicable)<br>[ ] Director [ ] 10% Owner<br>[ ] Officer (give title below) [X] Other (specify below)<br>_Member of 10% owner group_ |
| **2. Issuer Name and Ticker or Trading Symbol**<br>Heritage Insurance Holdings, Inc. [ HRTG ] | **4. If Amendment, Date of Original Filed (Month/Day/Year)**<br>  | **6. Individual or Joint/Group Filing (Check Applicable Line)**<br>[ ] Form filed by One Reporting Person<br>[X] Form filed by More than One Reporting Person |

---

---

| | | |
|:---|:---|:---|
| **1. Name and Address of Reporting Person**<sup>*</sup><br>TIRA TARA K<br><sub>(Last) (First) (Middle)</sub><br>3919 E 7TH AVENUE<br><sub>(Street)</sub><br>TAMPA, FL 33605<br><sub>(City) (State) (Zip)</sub> | **3. Date of Earliest Transaction (Month/Day/Year)**<br>2023-02-13 | **5. Relationship of Reporting Person(s) to Issuer**<br>(Check all applicable)<br>[ ] Director [ ] 10% Owner<br>[ ] Officer (give title below) [X] Other (specify below)<br>_Member of 10% owner group_ |
| **2. Issuer Name and Ticker or Trading Symbol**<br>Heritage Insurance Holdings, Inc. [ HRTG ] | **4. If Amendment, Date of Original Filed (Month/Day/Year)**<br>  | **6. Individual or Joint/Group Filing (Check Applicable Line)**<br>[ ] Form filed by One Reporting Person<br>[X] Form filed by More than One Reporting Person |

---

---

| | | |
|:---|:---|:---|
| **1. Name and Address of Reporting Person**<sup>*</sup><br>POOLE SEAN W<br><sub>(Last) (First) (Middle)</sub><br>3919 E 7TH AVE<br><sub>(Street)</sub><br>TAMPA, FL 33605<br><sub>(City) (State) (Zip)</sub> | **3. Date of Earliest Transaction (Month/Day/Year)**<br>2023-02-13 | **5. Relationship of Reporting Person(s) to Issuer**<br>(Check all applicable)<br>[ ] Director [ ] 10% Owner<br>[ ] Officer (give title below) [X] Other (specify below)<br>_Member of 10% owner group_ |
| **2. Issuer Name and Ticker or Trading Symbol**<br>Heritage Insurance Holdings, Inc. [ HRTG ] | **4. If Amendment, Date of Original Filed (Month/Day/Year)**<br>  | **6. Individual or Joint/Group Filing (Check Applicable Line)**<br>[ ] Form filed by One Reporting Person<br>[X] Form filed by More than One Reporting Person |

---

---

| | | |
|:---|:---|:---|
| **1. Name and Address of Reporting Person**<sup>*</sup><br>FUTURA CIRCUITS CORP.<br><sub>(Last) (First) (Middle)</sub><br>3919 E 7TH AVE<br><sub>(Street)</sub><br>TAMPA, FL 33605<br><sub>(City) (State) (Zip)</sub> | **3. Date of Earliest Transaction (Month/Day/Year)**<br>2023-02-13 | **5. Relationship of Reporting Person(s) to Issuer**<br>(Check all applicable)<br>[ ] Director [ ] 10% Owner<br>[ ] Officer (give title below) [X] Other (specify below)<br>_Member of 10% owner group_ |
| **2. Issuer Name and Ticker or Trading Symbol**<br>Heritage Insurance Holdings, Inc. [ HRTG ] | **4. If Amendment, Date of Original Filed (Month/Day/Year)**<br>  | **6. Individual or Joint/Group Filing (Check Applicable Line)**<br>[ ] Form filed by One Reporting Person<br>[X] Form filed by More than One Reporting Person |

---

---

| | | |
|:---|:---|:---|
| **1. Name and Address of Reporting Person**<sup>*</sup><br>HYER FAMILY PARTNERSHIP, LLC<br><sub>(Last) (First) (Middle)</sub><br>3919 E 7TH AVE<br><sub>(Street)</sub><br>TAMPA, FL 33605<br><sub>(City) (State) (Zip)</sub> | **3. Date of Earliest Transaction (Month/Day/Year)**<br>2023-02-13 | **5. Relationship of Reporting Person(s) to Issuer**<br>(Check all applicable)<br>[ ] Director [ ] 10% Owner<br>[ ] Officer (give title below) [X] Other (specify below)<br>_Member of 10% owner group_ |
| **2. Issuer Name and Ticker or Trading Symbol**<br>Heritage Insurance Holdings, Inc. [ HRTG ] | **4. If Amendment, Date of Original Filed (Month/Day/Year)**<br>  | **6. Individual or Joint/Group Filing (Check Applicable Line)**<br>[ ] Form filed by One Reporting Person<br>[X] Form filed by More than One Reporting Person |

---

## Table I - Non-Derivative Securities

---

|  |  |  |  |  |  |  |  |  |  |  |
| --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- |
| 1. Title of Security | 2. Transaction Date | 2A. Deemed Execution Date | 3. Transaction Code (V) | 3. Transaction Code (V) | 4. Securities Acquired (A) or Disposed of (D) | 4. Securities Acquired (A) or Disposed of (D) | 4. Securities Acquired (A) or Disposed of (D) | 5. Amount of Securities Beneficially Owned | 6. Ownership Form | 7. Nature of Indirect Beneficial Ownership |
| 1. Title of Security | 2. Transaction Date | 2A. Deemed Execution Date | Code | V | Amount | (A) or (D) | Price | 5. Amount of Securities Beneficially Owned | 6. Ownership Form | 7. Nature of Indirect Beneficial Ownership |
| COMMON STOCK | 2023-02-13 |  | P |  | 202460 | A | 1.96<sup>(1)</sup> | 2811115<sup>(2)</sup> | D |  |
| COMMON STOCK |  |  |  |  |  |  |  | 100000<sup>(3)</sup> | D |  |
| COMMON STOCK |  |  |  |  |  |  |  | 50000<sup>(4)</sup> | D |  |
| COMMON STOCK |  |  |  |  |  |  |  | 22000<sup>(5)</sup> | D |  |
| COMMON STOCK |  |  |  |  |  |  |  | 460000<sup>(6)</sup> | I | see footnote |
| COMMON STOCK |  |  |  |  |  |  |  | 120000<sup>(7)</sup> | I | see footnote |

---

## Table II - Derivative Securities

---

|  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |
| --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- |
| 1. Title of Derivative Security | 2. Conversion or Exercise Price | 3. Transaction Date | 3A. Deemed Execution Date | 4. Transaction Code (V) | 4. Transaction Code (V) | 5. Number of Derivative Securities Acquired (A) or Disposed of (D) | 5. Number of Derivative Securities Acquired (A) or Disposed of (D) | 6. Date Exercisable and Expiration Date | 6. Date Exercisable and Expiration Date | 7. Title and Amount of Underlying Securities | 7. Title and Amount of Underlying Securities | 8. Price of Derivative Security | 9. Number of Derivative Securities Beneficially Owned | 10. Ownership Form | 11. Nature of Indirect Beneficial Ownership |
| 1. Title of Derivative Security | 2. Conversion or Exercise Price | 3. Transaction Date | 3A. Deemed Execution Date | Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | 8. Price of Derivative Security | 9. Number of Derivative Securities Beneficially Owned | 10. Ownership Form | 11. Nature of Indirect Beneficial Ownership |
|  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |

---

### Footnotes:

(1) The price reported in column 4 is a weighted average price. The shares were purchased in multiple transactions at prices ranging from $1.93 to $2.00, 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) These securities are owned solely by Kathleen Hyer. Raymond T. Hyer may be deemed to have a pecuniary interest in these securities.

(4) These securities are owned solely by Tara Tira.

(5) These securities are owned solely by Sean W. Poole.

(6) These securities are held of record by Futura Circuits Corp., which is 100% owned by Raymond T. Hyer.

(7) 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.

**Signature:** /s/ Raymond T. Hyer  
**Date:** 2023-02-15

**Signature:** /s/ Kathleen A. Hyer, by Raymond T. Hyer as attorney-in fact  
**Date:** 2023-02-15

**Signature:** /s/ Tara K. Tira, by Raymond T. Hyer as attorney-in fact  
**Date:** 2023-02-15

**Signature:** /s/ Sean W. Poole, by Raymond T. Hyer as attorney-in fact  
**Date:** 2023-02-15

**Signature:** /s/ Raymond T. Hyer (P of Futura Circuits  
**Date:** 2023-02-15

**Signature:** /s/ Sean Poole, (Mgr of HFP), by Raymond T. Hyer as attorney-in fact  
**Date:** 2023-02-15

### Remarks:

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.**