0001214659-21-009426.txt : 20210910
0001214659-21-009426.hdr.sgml : 20210910
20210910182335
ACCESSION NUMBER: 0001214659-21-009426
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20210908
FILED AS OF DATE: 20210910
DATE AS OF CHANGE: 20210910
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Knutzen Jonathan
CENTRAL INDEX KEY: 0001808325
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-38873
FILM NUMBER: 211248127
MAIL ADDRESS:
STREET 1: 7979 IVANHOE AVENUE, SUITE 500
CITY: LA JOLLA
STATE: CA
ZIP: 92121
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
marketforms-53802.xml
PRIMARY DOCUMENT
X0306
4
2021-09-08
0001761312
Palomar Holdings, Inc.
PLMR
0001808325
Knutzen Jonathan
7979 IVANHOE AVENUE, SUITE 500
LA JOLLA
CA
92037
false
true
false
false
Chief Risk Officer
Common Stock (RSUs)
2021-09-08
4
M
false
364
0.00
A
7622
D
Common Stock (RSUs)
2021-09-08
4
F
false
113
86.83
D
7509
D
Restricted Stock Units
0.00
2021-09-08
4
M
false
364
0.00
D
Common Stock
364
727
D
This entry represents the number of shares of common stock withheld by the Issuer to satisfy the tax withholding obligation of the Reporting Person. These shares were not sold by the Reporting Person but were instead offset from the total number of vested shares received by the Reporting Person from the Issuer.
Includes 1,117 shares purchased pursuant to the Palomar Holdings, Inc. 2019 Employee Stock Purchase Plan (ESPP).
The original RSU grant was for 1,091 shares on 9/8/2020. 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
2021-09-10