0000899243-19-024626.txt : 20191002
0000899243-19-024626.hdr.sgml : 20191002
20191002132133
ACCESSION NUMBER: 0000899243-19-024626
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20190927
FILED AS OF DATE: 20191002
DATE AS OF CHANGE: 20191002
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Sharps Lewis S.
CENTRAL INDEX KEY: 0001770680
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-38814
FILM NUMBER: 191131441
MAIL ADDRESS:
STREET 1: 100 BERWYN PARK
STREET 2: 850 CASSATT ROAD, SUITE 220
CITY: BERWYN
STATE: PA
ZIP: 19312
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: POSITIVE PHYSICIANS HOLDINGS, INC.
CENTRAL INDEX KEY: 0001752039
STANDARD INDUSTRIAL CLASSIFICATION: FIRE, MARINE & CASUALTY INSURANCE [6331]
IRS NUMBER: 830824448
STATE OF INCORPORATION: PA
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 100 BERWYN PARK
STREET 2: 850 CASSATT ROAD, SUITE 220
CITY: BERWYN
STATE: PA
ZIP: 19312
BUSINESS PHONE: 8883355335
MAIL ADDRESS:
STREET 1: 100 BERWYN PARK
STREET 2: 850 CASSATT ROAD, SUITE 220
CITY: BERWYN
STATE: PA
ZIP: 19312
FORMER COMPANY:
FORMER CONFORMED NAME: POSITIVE PHYSICIANS HOLDINGS,INC.
DATE OF NAME CHANGE: 20180905
4
1
doc4.xml
FORM 4 SUBMISSION
X0306
4
2019-09-27
0
0001752039
POSITIVE PHYSICIANS HOLDINGS, INC.
PPHI
0001770680
Sharps Lewis S.
100 BERWYN PARK, SUITE 220
850 CASSATT ROAD
BERWYN
PA
19312
1
1
0
0
President and CEO
Option to Purchase
12.01
2019-09-27
4
A
0
216930
0.00
D
2019-10-27
2027-09-27
Common Stock
216930
0
D
Options to purchase 108,465 shares pursuant to a three and one-half-year period, with options vesting monthly in equal monthly amounts, and options to purchase 108,465 shares with vesting based on achievement of certain milestones by the Company.
/s/ Lewis S. Sharps, M.D.
2019-09-27