0001214659-23-012587.txt : 20230922
0001214659-23-012587.hdr.sgml : 20230922
20230922173814
ACCESSION NUMBER: 0001214659-23-012587
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20230908
FILED AS OF DATE: 20230922
DATE AS OF CHANGE: 20230922
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: 231272601
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-62695.xml
PRIMARY DOCUMENT
X0508
4
2023-09-08
0001761312
Palomar Holdings, Inc.
PLMR
0001808996
Johnson Michelle Antoinette
7979 IVANHOE AVENUE, SUITE 500
LA JOLLA
CA
92037
false
true
false
false
Chief People & Prod. Officer
0
Common Stock
2454
D
Common Stock (RSUs)
2023-09-08
4
M
false
242
0.00
A
2696
D
Common Stock (RSUs)
2023-09-08
4
F
false
84
51.27
D
2612
D
Restricted Stock Units
0.00
2023-09-08
4
M
false
242
0.00
D
Common Stock
242
0
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 717 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/ Angela Grant, Attorney-in-Fact
2023-09-21