0001140361-20-012190.txt : 20200521 0001140361-20-012190.hdr.sgml : 20200521 20200521165302 ACCESSION NUMBER: 0001140361-20-012190 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 2 CONFORMED PERIOD OF REPORT: 20200519 FILED AS OF DATE: 20200521 DATE AS OF CHANGE: 20200521 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Clark James Ryan CENTRAL INDEX KEY: 0001772377 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38873 FILM NUMBER: 20902578 MAIL ADDRESS: STREET 1: 7979 IVANHOE AVENUE STREET 2: SUITE 500 CITY: LA JOLLA STATE: CA ZIP: 92037 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Stargen V AIV, L.P. CENTRAL INDEX KEY: 0001772626 STATE OF INCORPORATION: E9 FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38873 FILM NUMBER: 20902579 BUSINESS ADDRESS: STREET 1: FOUR EMBARCADERO CENTER STREET 2: SUITE 1900 CITY: SAN FRANCISCO STATE: CA ZIP: 94111 BUSINESS PHONE: 415-834-2360 MAIL ADDRESS: STREET 1: FOUR EMBARCADERO CENTER STREET 2: SUITE 1900 CITY: SAN FRANCISCO STATE: CA ZIP: 94111 FORMER NAME: FORMER CONFORMED NAME: Stargen V AIV, LP DATE OF NAME CHANGE: 20190402 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Genstar Capital Partners V AIV, L.P. CENTRAL INDEX KEY: 0001772560 STATE OF INCORPORATION: E9 FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38873 FILM NUMBER: 20902580 BUSINESS ADDRESS: STREET 1: FOUR EMBARCADERO CENTER STREET 2: SUITE 1900 CITY: SAN FRANCISCO STATE: CA ZIP: 94111 BUSINESS PHONE: 415-834-2360 MAIL ADDRESS: STREET 1: FOUR EMBARCADERO CENTER STREET 2: SUITE 1900 CITY: SAN FRANCISCO STATE: CA ZIP: 94111 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Genstar Capital V AIV, L.P. CENTRAL INDEX KEY: 0001772561 STATE OF INCORPORATION: E9 FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38873 FILM NUMBER: 20902581 BUSINESS ADDRESS: STREET 1: FOUR EMBARCADERO CENTER STREET 2: SUITE 1900 CITY: SAN FRANCISCO STATE: CA ZIP: 94111 BUSINESS PHONE: 415-834-2360 MAIL ADDRESS: STREET 1: FOUR EMBARCADERO CENTER STREET 2: SUITE 1900 CITY: SAN FRANCISCO STATE: CA ZIP: 94111 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Genstar V GP AIV Ltd. CENTRAL INDEX KEY: 0001772563 STATE OF INCORPORATION: E9 FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38873 FILM NUMBER: 20902582 BUSINESS ADDRESS: STREET 1: FOUR EMBARCADERO CENTER STREET 2: SUITE 1900 CITY: SAN FRANCISCO STATE: CA ZIP: 94111 BUSINESS PHONE: 415-834-2360 MAIL ADDRESS: STREET 1: FOUR EMBARCADERO CENTER STREET 2: SUITE 1900 CITY: SAN FRANCISCO STATE: CA ZIP: 94111 FORMER NAME: FORMER CONFORMED NAME: Genstar V GP AIV LTD. DATE OF NAME CHANGE: 20190402 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Stargen VI AIV, L.P. CENTRAL INDEX KEY: 0001772628 STATE OF INCORPORATION: E9 FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38873 FILM NUMBER: 20902583 BUSINESS ADDRESS: STREET 1: FOUR EMBARCADERO CENTER STREET 2: SUITE 1900 CITY: SAN FRANCISCO STATE: CA ZIP: 94111 BUSINESS PHONE: 415-834-2360 MAIL ADDRESS: STREET 1: FOUR EMBARCADERO CENTER STREET 2: SUITE 1900 CITY: SAN FRANCISCO STATE: CA ZIP: 94111 FORMER NAME: FORMER CONFORMED NAME: Stargen VI AIV, LP DATE OF NAME CHANGE: 20190402 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Genstar Capital Partners VI AIV (DEL), L.P. CENTRAL INDEX KEY: 0001772557 STATE OF INCORPORATION: E9 FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38873 FILM NUMBER: 20902584 BUSINESS ADDRESS: STREET 1: FOUR EMBARCADERO CENTER STREET 2: SUITE 1900 CITY: SAN FRANCISCO STATE: CA ZIP: 94111 BUSINESS PHONE: 415-834-2360 MAIL ADDRESS: STREET 1: FOUR EMBARCADERO CENTER STREET 2: SUITE 1900 CITY: SAN FRANCISCO STATE: CA ZIP: 94111 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Genstar Capital Partners VI AIV, L.P. CENTRAL INDEX KEY: 0001772559 STATE OF INCORPORATION: E9 FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38873 FILM NUMBER: 20902585 BUSINESS ADDRESS: STREET 1: FOUR EMBARCADERO CENTER STREET 2: SUITE 1900 CITY: SAN FRANCISCO STATE: CA ZIP: 94111 BUSINESS PHONE: 415-834-2360 MAIL ADDRESS: STREET 1: FOUR EMBARCADERO CENTER STREET 2: SUITE 1900 CITY: SAN FRANCISCO STATE: CA ZIP: 94111 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Genstar Capital VI AIV, L.P. CENTRAL INDEX KEY: 0001772562 STATE OF INCORPORATION: E9 FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38873 FILM NUMBER: 20902586 BUSINESS ADDRESS: STREET 1: FOUR EMBARCADERO CENTER STREET 2: SUITE 1900 CITY: SAN FRANCISCO STATE: CA ZIP: 94111 BUSINESS PHONE: 415-834-2360 MAIL ADDRESS: STREET 1: FOUR EMBARCADERO CENTER STREET 2: SUITE 1900 CITY: SAN FRANCISCO STATE: CA ZIP: 94111 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Genstar VI GP AIV Ltd. CENTRAL INDEX KEY: 0001772564 STATE OF INCORPORATION: E9 FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38873 FILM NUMBER: 20902587 BUSINESS ADDRESS: STREET 1: FOUR EMBARCADERO CENTER STREET 2: SUITE 1900 CITY: SAN FRANCISCO STATE: CA ZIP: 94111 BUSINESS PHONE: 415-834-2360 MAIL ADDRESS: STREET 1: FOUR EMBARCADERO CENTER STREET 2: SUITE 1900 CITY: SAN FRANCISCO STATE: CA ZIP: 94111 FORMER NAME: FORMER CONFORMED NAME: Genstar VI GP AIV LTD. DATE OF NAME CHANGE: 20190402 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 form4.xml FORM 4 X0306 4 2020-05-19 true 0001761312 Palomar Holdings, Inc. PLMR 0001772564 Genstar VI GP AIV Ltd. C/O GENSTAR CAPITAL LLC FOUR EMBARCADERO CENTER, SUITE 1900 SAN FRANCISCO CA 94111 true 0001772562 Genstar Capital VI AIV, L.P. C/O GENSTAR CAPITAL LLC FOUR EMBARCADERO CENTER, SUITE 1900 SAN FRANCISCO CA 94111 true 0001772559 Genstar Capital Partners VI AIV, L.P. C/O GENSTAR CAPITAL LLC FOUR EMBARCADERO CENTER, SUITE 1900 SAN FRANCISCO CA 94111 true 0001772557 Genstar Capital Partners VI AIV (DEL), L.P. C/O GENSTAR CAPITAL LLC FOUR EMBARCADERO CENTER, SUITE 1900 SAN FRANCISCO CA 94111 true 0001772628 Stargen VI AIV, L.P. C/O GENSTAR CAPITAL LLC FOUR EMBARCADERO CENTER, SUITE 1900 SAN FRANCISCO CA 94111 true 0001772563 Genstar V GP AIV Ltd. C/O GENSTAR CAPITAL LLC FOUR EMBARCADERO CENTER, SUITE 1900 SAN FRANCISCO CA 94111 true 0001772561 Genstar Capital V AIV, L.P. C/O GENSTAR CAPITAL LLC FOUR EMBARCADERO CENTER, SUITE 1900 SAN FRANCISCO CA 94111 true 0001772560 Genstar Capital Partners V AIV, L.P. C/O GENSTAR CAPITAL LLC FOUR EMBARCADERO CENTER, SUITE 1900 SAN FRANCISCO CA 94111 true 0001772626 Stargen V AIV, L.P. C/O GENSTAR CAPITAL LLC FOUR EMBARCADERO CENTER, SUITE 1900 SAN FRANCISCO CA 94111 true 0001772377 Clark James Ryan C/O GENSTAR CAPITAL LLC FOUR EMBARCADERO CENTER, SUITE 1900 SAN FRANCISCO CA 94111 true Common Stock 2020-05-19 4 S 0 1063139 61.11 D 0 I See Footnotes Common Stock 2020-05-19 4 S 0 72253 61.11 D 2408405 I See Footnotes Common Stock 0 D This report is filed by the following Reporting Persons: Genstar VI GP AIV Ltd. ("Genstar VI Ltd."); Genstar Capital VI AIV, L.P. ("Genstar VI GP"); Genstar Capital Partners VI AIV, L.P. ("Genstar VI"); Genstar Capital Partners VI AIV (DEL), L.P. ("Genstar VI DEL"); Stargen VI AIV, L.P. ("Stargen VI"); Genstar V GP AIV Ltd. ("Genstar V Ltd."); Genstar Capital V AIV, L.P. ("Genstar V GP"); Genstar Capital Partners V AIV, L.P. ("Genstar V"); Stargen V AIV, L.P. ("Stargen V"); and James Ryan Clark. Represents all of the shares of common stock held directly and sold by the following entities: 984,934 shares sold by Genstar VI; 40,723 shares sold by Genstar VI DEL; and 37,482 shares sold by Stargen VI. Genstar VI Ltd. is the general partner of Genstar VI GP, which in turn is the general partner of each of Genstar VI, Genstar VI DEL and Stargen VI. Represents all of the shares of common stock held directly and sold by Stargen V. Represents 2,408,405 shares of common stock held directly by Genstar V following the transaction. Genstar V Ltd. is the general partner of Genstar V GP, which in turn is the general partner of each of Genstar V and Stargen V. James Ryan Clark is, and continues to be following the transactions reported herein, a director of the Issuer. Mr. Clark is also a director of each of Genstar VI Ltd. and Genstar V Ltd. and does not directly or beneficially own any equity securities of the Issuer. This filing shall not be deemed an admission that for purposes of Section 16 of the Securities Exchange Act of 1934, as amended, or otherwise, that the Reporting Persons are the beneficial owners of any equity securities in excess of their respective pecuniary interests, and each Reporting Person disclaims beneficial ownership of the securities reported herein, except to the extent of such Reporting Person's pecuniary interest therein, if any. Exhibit 99.1 (Joint Filer Information) is incorporated herein by reference. /s/ James Ryan Clark, Director 2020-05-21 EX-99.1 2 ex99_1.htm EXHIBIT 99.1
Exhibit 99.1

Joint Filer Information

Name of Joint Filer:
Genstar Capital VI AIV, L.P.
   
Address of Joint Filer:
c/o Genstar Capital LLC
 
Four Embarcadero Center, Suite 1900
 
San Francisco, CA  94111
   
Relationship of Joint Filer to Issuer:
10% Owner
   
Issuer Name and Ticker or Trading Symbol:
Palomar Holdings, Inc. [PLMR]
   
Date of Event Requiring Statement
(Month/Day/Year):
May 19, 2020
   
Designated Filer:
Genstar VI GP AIV Ltd.

Signature:

GENSTAR CAPITAL VI AIV, L.P.
By:
GENSTAR VI GP AIV LTD., its General Partner
   
By:
/s/ James Ryan Clark
 
Name:
 James Ryan Clark
 
Title:
 Director
   
Dated: May 21, 2020

Joint Filer Information

(continued)

Name of Joint Filer:
Genstar Capital Partners VI AIV, L.P.
   
Address of Joint Filer:
c/o Genstar Capital LLC
 
Four Embarcadero Center, Suite 1900
 
San Francisco, CA  94111
   
Relationship of Joint Filer to Issuer:
10% Owner
   
Issuer Name and Ticker or Trading Symbol:
Palomar Holdings, Inc. [PLMR]
   
Date of Event Requiring Statement
(Month/Day/Year):
May 19, 2020
   
Designated Filer:
Genstar VI GP AIV Ltd.

Signature:

GENSTAR CAPITAL PARTNERS VI AIV, L.P.
By:
GENSTAR CAPITAL VI AIV, L.P., its General Partner
By:
GENSTAR VI GP AIV LTD., its General Partner
   
By:
/s/ James Ryan Clark
 
Name:
 James Ryan Clark
 
Title:
 Director
   
Dated: May 21, 2020

2
Joint Filer Information

(continued)

Name of Joint Filer:
Genstar Capital Partners VI AIV (DEL), L.P.
   
Address of Joint Filer:
c/o Genstar Capital LLC
 
Four Embarcadero Center, Suite 1900
 
San Francisco, CA  94111
   
Relationship of Joint Filer to Issuer:
10% Owner
   
Issuer Name and Ticker or Trading Symbol:
Palomar Holdings, Inc. [PLMR]
   
Date of Event Requiring Statement
(Month/Day/Year):
May 19, 2020
   
Designated Filer:
Genstar VI GP AIV Ltd.

Signature:

GENSTAR CAPITAL PARTNERS VI AIV (DEL), L.P.
By:
GENSTAR CAPITAL VI AIV, L.P., its General Partner
By:
GENSTAR VI GP AIV LTD., its General Partner
   
By:
/s/ James Ryan Clark
 
Name:
 James Ryan Clark
 
Title:
 Director
   
Dated: May 21, 2020

3
Joint Filer Information

(continued)

Name of Joint Filer:
Stargen VI AIV, L.P.
   
Address of Joint Filer:
c/o Genstar Capital LLC
 
Four Embarcadero Center, Suite 1900
 
San Francisco, CA  94111
   
Relationship of Joint Filer to Issuer:
10% Owner
   
Issuer Name and Ticker or Trading Symbol:
Palomar Holdings, Inc. [PLMR]
   
Date of Event Requiring Statement
  
(Month/Day/Year):
May 19, 2020
   
Designated Filer:
Genstar VI GP AIV Ltd.

Signature:

STARGEN VI AIV, L.P.
By:
GENSTAR CAPITAL VI AIV, L.P., its General Partner
By:
GENSTAR VI GP AIV LTD., its General Partner
   
By:
/s/ James Ryan Clark
 
Name:
 James Ryan Clark
 
Title:
 Director
   
Dated: May 21, 2020

4
Joint Filer Information

(continued)

Name of Joint Filer:
Genstar V GP AIV Ltd.
   
Address of Joint Filer:
c/o Genstar Capital LLC
 
Four Embarcadero Center, Suite 1900
 
San Francisco, CA  94111
   
Relationship of Joint Filer to Issuer:
10% Owner
   
Issuer Name and Ticker or Trading Symbol:
Palomar Holdings, Inc. [PLMR]
   
Date of Event Requiring Statement
(Month/Day/Year):
May 19, 2020
   
Designated Filer:
Genstar VI GP AIV Ltd.

Signature:

GENSTAR V GP AIV LTD.
   
By:
/s/ James Ryan Clark
 
Name:
 James Ryan Clark
 
Title:
 Director
   
Dated: May 21, 2020

5
Joint Filer Information

(continued)

Name of Joint Filer:
Genstar Capital V AIV, L.P.
   
Address of Joint Filer:
c/o Genstar Capital LLC
 
Four Embarcadero Center, Suite 1900
 
San Francisco, CA  94111
   
Relationship of Joint Filer to Issuer:
10% Owner
   
Issuer Name and Ticker or Trading Symbol:
Palomar Holdings, Inc. [PLMR]
   
Date of Event Requiring Statement
(Month/Day/Year):
May 19, 2020
   
Designated Filer:
Genstar VI GP AIV Ltd.

Signature:

GENSTAR CAPITAL V AIV, L.P.
By:
GENSTAR V GP AIV LTD., its General Partner
   
By:
/s/ James Ryan Clark
 
Name:
 James Ryan Clark
 
Title:
 Director
   
Dated: May 21, 2020

6
Joint Filer Information

(continued)

Name of Joint Filer:
Genstar Capital Partners V AIV, L.P.
   
Address of Joint Filer:
c/o Genstar Capital LLC
 
Four Embarcadero Center, Suite 1900
 
San Francisco, CA  94111
   
Relationship of Joint Filer to Issuer:
10% Owner
   
Issuer Name and Ticker or Trading Symbol:
Palomar Holdings, Inc. [PLMR]
   
Date of Event Requiring Statement
(Month/Day/Year):
May 19, 2020
   
Designated Filer:
Genstar VI GP AIV Ltd.

Signature:

GENSTAR CAPITAL PARTNERS V AIV, L.P.
By:
GENSTAR CAPITAL V AIV, L.P., its General Partner
By:
GENSTAR V GP AIV LTD., its General Partner
   
By:
/s/ James Ryan Clark
 
Name:
 James Ryan Clark
 
Title:
 Director
   
Dated: May 21, 2020

7
Joint Filer Information

(continued)

Name of Joint Filer:
Stargen V AIV, L.P.
   
Address of Joint Filer:
c/o Genstar Capital LLC
 
Four Embarcadero Center, Suite 1900
 
San Francisco, CA  94111
   
Relationship of Joint Filer to Issuer:
10% Owner
   
Issuer Name and Ticker or Trading Symbol:
Palomar Holdings, Inc. [PLMR]
   
Date of Event Requiring Statement
(Month/Day/Year):
May 19, 2020
   
Designated Filer:
Genstar VI GP AIV Ltd.

Signature:

STARGEN V AIV, L.P.
By:
GENSTAR CAPITAL V AIV, L.P., its General Partner
By:
GENSTAR V GP AIV LTD., its General Partner
   
By:
/s/ James Ryan Clark

Name:
 James Ryan Clark

Title:
 Director



Dated: May 21, 2020

8
Joint Filer Information

(continued)

Name of Joint Filer:
James Ryan Clark
   
Address of Joint Filer:
c/o Genstar Capital LLC
 
Four Embarcadero Center, Suite 1900
 
San Francisco, CA  94111
   
Relationship of Joint Filer to Issuer:
Director
   
Issuer Name and Ticker or Trading Symbol:
Palomar Holdings, Inc. [PLMR]
   
Date of Event Requiring Statement
(Month/Day/Year):
May 19, 2020
   
Designated Filer:
Genstar VI GP AIV Ltd.

Signature:

By:
/s/ James Ryan Clark

Name:
 James Ryan Clark

 
Dated: May 21, 2020


9