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