0001214659-21-011512.txt : 20211112 0001214659-21-011512.hdr.sgml : 20211112 20211112112817 ACCESSION NUMBER: 0001214659-21-011512 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20210908 FILED AS OF DATE: 20211112 DATE AS OF CHANGE: 20211112 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: 211401544 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 marketforms-53801.xml PRIMARY DOCUMENT X0306 4 2021-09-08 0001761312 Palomar Holdings, Inc. PLMR 0001808996 Johnson Michelle Antoinette 7979 IVANHOE AVENUE, SUITE 500 LA JOLLA CA 92037 false true false false Chief Talent & Div. Officer Common Stock (RSUs) 2021-09-08 4 M false 242 0.00 A 336 D Common Stock (RSUs) 2021-09-08 4 F false 85 86.83 D 251 D Restricted Stock Units 0.00 2021-09-08 4 M false 242 0.00 D Common Stock 242 485 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 94 shares purchased pursuant to the Palomar Holdings, Inc. 2019 Employee Stock Purchase Plan (ESPP). The original RSU grant was for 727 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