# EDGAR Filing Document

**Accession Number:** 0002067129
**File Stem:** 0001193125-25-230522
**Filing Date:** 2025-10
**Character Count:** 11057
**Document Hash:** dd163fb91ca8f852cab1d601756d09c4
**Contains OCR:** False
**Source Format:** 

## Filing Content

## Filing Summary
**0001193125-25-230522.hdr.sgml**: 20251003

**ACCESSION NUMBER**: 0001193125-25-230522

**CONFORMED SUBMISSION TYPE**: 4

**PUBLIC DOCUMENT COUNT**: 1

**CONFORMED PERIOD OF REPORT**: 20251002

**FILED AS OF DATE**: 20251003

**DATE AS OF CHANGE**: 20251003

**REPORTING-OWNER**: 

**OWNER DATA:**
- **COMPANY CONFORMED NAME:** Burgess Trevor R
- **CENTRAL INDEX KEY:** 0001613062

**ORGANIZATION NAME:**

**FILING VALUES:**
- **FORM TYPE:** 4
- **SEC ACT:** 1934 Act
- **SEC FILE NUMBER:** 001-42878
- **FILM NUMBER:** 251375161

**MAIL ADDRESS:**
- **STREET 1:** C1 FINANCIAL, INC.
- **STREET 2:** 100 5TH STREET SOUTH
- **CITY:** ST. PETERSBURG
- **STATE:** FL
- **ZIP:** 33701
**ISSUER**: 

**COMPANY DATA:**
- **COMPANY CONFORMED NAME:** Neptune Insurance Holdings Inc.
- **CENTRAL INDEX KEY:** 0002067129
- **STANDARD INDUSTRIAL CLASSIFICATION:** INSURANCE AGENTS BROKERS & SERVICES [6411]
- **ORGANIZATION NAME:** 02 Finance
- **EIN:** 334189588
- **STATE OF INCORPORATION:** DE
- **FISCAL YEAR END:** 1231

**BUSINESS ADDRESS:**
- **STREET 1:** 400 6TH ST S
- **CITY:** ST. PETERSBURG
- **STATE:** FL
- **ZIP:** 33701
- **BUSINESS PHONE:** (727) 202-4815

**MAIL ADDRESS:**
- **STREET 1:** 400 6TH ST S
- **CITY:** ST. PETERSBURG
- **STATE:** FL
- **ZIP:** 33701

**FORMER COMPANY:**
- **FORMER CONFORMED NAME:** Neptune Insurance Holdings, Inc.
- **DATE OF NAME CHANGE:** 20250506

### 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>Burgess Trevor R<br><sub>(Last) (First) (Middle)</sub><br>C/O NEPTUNE INSURANCE HOLDINGS INC.<br>400 6TH STREET S, SUITE 2<br><sub>(Street)</sub><br>ST. PETERSBURG, FL 33701<br><sub>(City) (State) (Zip)</sub> | **3. Date of Earliest Transaction (Month/Day/Year)**<br>2025-10-02 | **5. Relationship of Reporting Person(s) to Issuer**<br>(Check all applicable)<br>[X] Director [X] 10% Owner<br>[X] Officer (give title below) [ ] Other (specify below)<br>_CEO & Chairman of the Board_ |
| **2. Issuer Name and Ticker or Trading Symbol**<br>Neptune Insurance Holdings Inc. [ NP ] | **4. If Amendment, Date of Original Filed (Month/Day/Year)**<br>  | **6. Individual or Joint/Group Filing (Check Applicable Line)**<br>[X] Form filed by One Reporting Person<br>[ ] 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 | 2025-10-02 |  | J<sup>(1)</sup> |  | 25039000 | D | <sup>(1)</sup> | 0 | I | Held by Burgess Family SLAT, u/a/d March 26, 2025<sup>(2)</sup> |
| Class A Common Stock | 2025-10-02 |  | J<sup>(1)</sup> |  | 25039000 | A | <sup>(1)</sup> | 25039000 | I | Held by Burgess Family SLAT, u/a/d March 26, 2025<sup>(2)</sup> |
| Class A Common Stock | 2025-10-02 |  | J<sup>(3)</sup> |  | 25039000 | D | <sup>(3)</sup> | 0 | I | Held by Burgess Family SLAT, u/a/d March 26, 2025<sup>(2)</sup> |
| Common Stock | 2025-10-02 |  | J<sup>(1)</sup> |  | 17885000 | D | <sup>(1)</sup> | 0 | I | Held by the Trevor R. Burgess Irrevocable Trust of 2020, u/a/d March 24, 2025<sup>(4)</sup> |
| Class A Common Stock | 2025-10-02 |  | J<sup>(1)</sup> |  | 17885000 | A | <sup>(1)</sup> | 17885000 | I | Held by the Trevor R. Burgess Irrevocable Trust of 2020, u/a/d March 24, 2025<sup>(4)</sup> |
| Class A Common Stock | 2025-10-02 |  | J<sup>(3)</sup> |  | 17885000 | D | <sup>(3)</sup> | 0 | I | Held by the Trevor R. Burgess Irrevocable Trust of 2020, u/a/d March 24, 2025<sup>(4)</sup> |
| Common Stock | 2025-10-02 |  | J<sup>(1)</sup> |  | 511000 | D | <sup>(1)</sup> | 0 | I | Held by the Trevor R. Burgess Revocable Trust, u/a/d September 30, 2024<sup>(2)</sup> |
| Class A Common Stock | 2025-10-02 |  | J<sup>(1)</sup> |  | 511000 | A | <sup>(1)</sup> | 511000 | I | Held by the Trevor R. Burgess Revocable Trust, u/a/d September 30, 2024<sup>(2)</sup> |
| Class A Common Stock | 2025-10-02 |  | J<sup>(3)</sup> |  | 511000 | D | <sup>(3)</sup> | 0 | I | Held by the Trevor R. Burgess Revocable Trust, u/a/d September 30, 2024<sup>(2)</sup> |
| Class A Common Stock | 2025-10-02 |  | A |  | 1982964<sup>(5)</sup> | A | $0 | 1982964 | D |  |

---

## 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 |
| Class B Common Stock | <sup>(6)</sup> | 2025-10-02 |  | J<sup>(3)</sup> |  | 25039000 |  | <sup>(6)</sup> | <sup>(6)</sup> | Class A Common Stock | 25039000 | <sup>(6)</sup> | 25039000 | I | Held by Burgess Family SLAT, u/a/d March 26, 2025<sup>(2)</sup> |
| Class B Common Stock | <sup>(6)</sup> | 2025-10-02 |  | J<sup>(3)</sup> |  | 17885000 |  | <sup>(6)</sup> | <sup>(6)</sup> | Class A Common Stock | 17885000 | <sup>(6)</sup> | 17885000 | I | Held by the Trevor R. Burgess Irrevocable Trust of 2020, u/a/d March 24, 2025<sup>(4)</sup> |
| Class B Common Stock | <sup>(6)</sup> | 2025-10-02 |  | J<sup>(3)</sup> |  | 511000 |  | <sup>(6)</sup> | <sup>(6)</sup> | Class A Common Stock | 511000 | <sup>(6)</sup> | 511000 | I | Held by the Trevor R. Burgess Revocable Trust, u/a/d September 30, 2024<sup>(2)</sup> |
| Stock Option (right to buy) | $5.495 | 2025-10-02 |  | J<sup>(1)</sup> |  |  | 5880000 | <sup>(7)</sup> | 2033-11-09 | Common Stock<sup>(1)</sup> | 5880000 | $0 | 0 | D |  |
| Stock Option (right to buy) | $5.495 | 2025-10-02 |  | J<sup>(1)</sup> |  | 5880000 |  | <sup>(7)</sup> | 2033-11-09 | Class A Common Stock<sup>(1)(7)</sup> | 5880000 | $0 | 5880000 | D |  |
| Stock Option (right to buy) | $5.495 | 2025-10-02 |  | J<sup>(1)</sup> |  |  | 280000 | <sup>(7)</sup> | 2035-03-08 | Common Stock<sup>(1)</sup> | 280000 | $0 | 0 | D |  |
| Stock Option (right to buy) | $5.495 | 2025-10-02 |  | J<sup>(1)</sup> |  | 280000 |  | <sup>(7)</sup> | 2035-03-08 | Class A Common Stock<sup>(1)(7)</sup> | 280000 | $0 | 280000 | D |  |

---

### Footnotes:

(1) Pursuant to a reclassification exempt under Rule 16b-7, shares of Common Stock were automatically reclassified as shares of Class A Common Stock on a one-for-one basis upon the filing of the Second Amended and Restated Certificate of Incorporation of the Issuer immediately prior to the closing of the Issuer's initial public offering ("IPO").

(2) The Reporting Person is the trustee of the trust.

(3) Shares of Class A Common Stock were exchanged with the Issuer for shares of Class B Common Stock on a one-for-one basis pursuant to the Exchange Agreement between the Reporting Person and the Issuer.

(4) Jonathan W. Meyer and David J. Rectenwald are Co-Trustees of the trust and may be replaced at the discretion of the Reporting Person. By virtue of his relationship with the trust, the Reporting Person is deemed to have an indirect beneficial interest in the shares held by the trust. The Reporting Person disclaims beneficial ownership of the shares held by the trust.

(5) Represents shares of Class A Common Stock underlying an award of time-based restricted stock units ("RSUs"). The RSUs will vest in equal annual installments over three years, beginning on September 30, 2026, subject to the continuous service of the Reporting Person through each vesting date. Each share of Class A Common Stock received upon the settlement of the RSU may be exchanged by the Reporting Person into one share of the Issuer's Class B Common Stock.

(6) Each outstanding share of Class B Common Stock is convertible into one share of the Issuer's Class A common stock at any time, (i) at the option of the Reporting Person, (ii) automatically upon any transfer, whether or not for value (except for certain permitted transfers), or (iii) upon the occurrence of certain events or conditions, as described further in the Issuer's Second Amended and Restated Certificate of Incorporation.

(7) The stock option fully vested upon the closing of (and became exercisable in connection with) the IPO. Each share of Class A Common Stock received upon the exercise of the stock option may be exchanged by the Reporting Person into one share of the Issuer's Class B Common Stock.

**Signature:** /s/ James Steiner, by power of attorney  
**Date:** 2025-10-03

### 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.**