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