0001104659-20-104070.txt : 20200910 0001104659-20-104070.hdr.sgml : 20200910 20200910192051 ACCESSION NUMBER: 0001104659-20-104070 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20200908 FILED AS OF DATE: 20200910 DATE AS OF CHANGE: 20200910 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Johnson Michelle Antoinette CENTRAL INDEX KEY: 0001808996 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38873 FILM NUMBER: 201169617 MAIL ADDRESS: STREET 1: 7979 IVANHOE AVENUE, SUITE 500 CITY: LA JOLLA STATE: CA ZIP: 92037 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Palomar Holdings, Inc. CENTRAL INDEX KEY: 0001761312 STANDARD INDUSTRIAL CLASSIFICATION: FIRE, MARINE & CASUALTY INSURANCE [6331] IRS NUMBER: 000000000 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 7979 IVANHOE AVENUE STREET 2: SUITE 500 CITY: LA JOLLA STATE: CA ZIP: 92037 BUSINESS PHONE: 619-567-5290 MAIL ADDRESS: STREET 1: 7979 IVANHOE AVENUE STREET 2: SUITE 500 CITY: LA JOLLA STATE: CA ZIP: 92037 FORMER COMPANY: FORMER CONFORMED NAME: GC Palomar Holdings DATE OF NAME CHANGE: 20181211 4 1 a4.xml 4 X0306 4 2020-09-08 0 0001761312 Palomar Holdings, Inc. PLMR 0001808996 Johnson Michelle Antoinette 7979 IVANHOE AVENUE, SUITE 500 LA JOLLA CA 92037 0 1 0 0 Senior VP, People & Talent Employee Stock Options (right to buy) 98.95 2020-09-08 4 A 0 727 0 A 2030-09-08 Common Stock 727 727 D Restricted Stock Units 0 2020-09-08 4 A 0 727 0 A Common Stock 727 727 D Subject to continuing service with the Company, the option shall vest as follows: twenty-five percent (25%) shall vest on the first year anniversary of the date of the grant and the remaining shall vest in equal monthly installments over the subsequent thirty-six (36) month period. Each restricted stock unit represents a contingent right to receive one share of Palomar Holdings, Inc. Common Stock. Subject to continuing service with the Company, the restricted stock units shall vest as follows: one-third (1/3) shall vest on the first year anniversary of the date of the grant; an additional one-third (1/3) shall vest on the second year anniversary of the date of the grant; and the final one-third (1/3) shall vest on the third year anniversary of the date of grant. /s/ Christopher Uchida, Attorney-in-Fact 2020-09-10