0001214659-22-014117.txt : 20221122 0001214659-22-014117.hdr.sgml : 20221122 20221122163216 ACCESSION NUMBER: 0001214659-22-014117 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20221118 FILED AS OF DATE: 20221122 DATE AS OF CHANGE: 20221122 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: 221410885 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-57575.xml PRIMARY DOCUMENT X0306 4 2022-11-18 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 8861 D Common Stock (RSUs) 2022-11-18 4 M false 2448 0.00 A 11309 D Common Stock (RSUs) 2022-11-18 4 F false 822 60.02 D 10487 D Restricted Stock Units 0.00 2022-11-18 4 M false 2448 0.00 D Common Stock 2448 9790 D Represents shares automatically sold by the Company on behalf of the Reporting Person pursuant to a mandatory sell-to-cover provision in the RSU award agreement required to cover minimum statutory tax withholding obligations that became due upon the RSU vesting event. Includes 1,177 shares purchased pursuant to the Palomar Holdings, Inc. 2019 Employee Stock Purchase Plan (ESPP). The original RSU grant was for 12,238 shares on 11/18/2021. Subject to continuing service with the Company, the restricted stock units shall vest as follows: 2,448 units shall vest on the first year anniversary of the date of the grant; 2,447 units shall vest on the second year anniversary of the date of the grant; 2,447 units shall vest on the third year anniversary of the date of grant; and 612 units shall vest quarterly following the third anniversary date of the grant. /s/ Angela Grant, Attorney-in-Fact 2022-11-18