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UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(h) of the Investment Company Act of 1940 |
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | |||
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 control number. | SEC 1474 (9-02) |
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 Underlying Securities (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 of Derivative Security: Direct (D) or Indirect (I) (Instr. 4) |
11. Nature of Indirect Beneficial Ownership (Instr. 4) |
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Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||||||
Stock Option (Right to Buy) | $ 16.89 | 11/09/2015 | M | 787 | (2) | 12/02/2017 | Common Stock | 787 | $ 0 | 24,213 | D | ||||
Stock Option (Right to Buy) | $ 16.89 | 11/10/2015 | M | 20,000 | (2) | 12/02/2017 | Common Stock | 20,000 | $ 0 | 4,213 | D | ||||
Stock Option (Right to Buy) | $ 16.89 | 11/11/2015 | M | 4,213 | (2) | 12/02/2017 | Common Stock | 4,213 | $ 0 | 0 | D | ||||
Stock Option (Right to Buy) | $ 14.02 | 11/11/2015 | M | 5,000 | 03/15/2015 | 09/24/2017 | Common Stock | 5,000 | $ 0 | 0 | D |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
Neilson Paul C/O HERITAGE INSURANCE HOLDINGS, INC. 2600 MCCORMICK DRIVE SUITE 300 CLEARWATER, FL 33759 |
Vice President of Claims |
/s/ Bruce Lucas, by Power of Attorney | 11/12/2015 | |
**Signature of Reporting Person | Date |
* | 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). |
(1) | The price is the weighted average price for the transactions reported on this line. The range of prices for the transactions reported on this line is between $23.55 and $23.67 per share. Complete information regarding the number of shares sold at each separate price will be provided upon request by the Commission Staff, the issuer or a security holder of the issuer. |
(2) | Fifty percent (50%) of the stock options reported on this line were immediately vested on the grant date, and the remaining fifty percent (50%) vested on April 30, 2015. |
Remarks: The reporting person initially filed a Form 4 on August 19, 2014 (the "Initial Form 4") reporting the award of stock options to purchase 5,000 shares of common stock. However, the Company never completed the stock option award due to certain fundamental calculation errors and, accordingly, the purported stock option award is null and void. Therefore, the Initial Form 4 was filed in error, and this amended report is correcting the error by removing the null and void award. |