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