0001104659-20-132842.txt : 20201207
0001104659-20-132842.hdr.sgml : 20201207
20201207160542
ACCESSION NUMBER: 0001104659-20-132842
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20201203
FILED AS OF DATE: 20201207
DATE AS OF CHANGE: 20201207
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Taketa Richard H
CENTRAL INDEX KEY: 0001772375
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-38873
FILM NUMBER: 201372779
MAIL ADDRESS:
STREET 1: 7979 IVANHOE AVENUE
STREET 2: 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
2020-12-03
0
0001761312
Palomar Holdings, Inc.
PLMR
0001772375
Taketa Richard H
7979 IVANHOE AVENUE, SUITE 500
LA JOLLA
CA
92037
1
0
0
0
Common Stock
2020-12-03
4
P
0
750
67.00
A
38352
D
The amount reported includes 334 Restricted Stock Units (RSUs) previously granted to the Reporting Person pursuant to the Issuer's 2019 Equity Incentive Plan (the "Plan"), which shall vest upon the earlier of (i) 5/28/2021 or (ii) immediately prior to the Issuer's 2021 Annual Meeting, subject to the Reporting Person's continuing Service (as defined in the Plan) with the Issuer.
/s/ Christopher Uchida, as Attorney-in-Fact
2020-12-07