0001214659-24-000205.txt : 20240103 0001214659-24-000205.hdr.sgml : 20240103 20240103184021 ACCESSION NUMBER: 0001214659-24-000205 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20240101 FILED AS OF DATE: 20240103 DATE AS OF CHANGE: 20240103 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Johnson Michelle Antoinette CENTRAL INDEX KEY: 0001808996 ORGANIZATION NAME: FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38873 FILM NUMBER: 24508905 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] ORGANIZATION NAME: 02 Finance 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-64004.xml PRIMARY DOCUMENT X0508 4 2024-01-01 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 1797 D Common Stock (PSUs) 2024-01-01 4 M false 402 0.00 A 2199 D Common Stock (PSUs) 2024-01-01 4 S false 115 54.5181 D 2084 D Common Stock (PSUs) 2024-01-01 4 S false 54 54.5000 D 2030 D Includes 349 shares purchased pursuant to the Palomar Holdings, Inc. 2019 Employee Stock Purchase Plan (ESPP). Represents the date on which previously granted performance stock unit ("PSU") awards were determined to be vested based on the grantee completing the required service period. Represents the number of shares of common stock determined to have been earned and vested from a previously granted PSU award. The PSU award was granted on 1/27/2021 and the number of shares that vested was based on achievement of certain company financial performance criteria and the grantee completing the required service period through 1/1/2024. Represents shares automatically sold by the Company on behalf of the Reporting Person pursuant to a mandatory sell-to-cover provision in the PSU award agreement required to cover minimum statutory tax withholding obligations that became due upon the PSU vesting event. /s/ Angela Grant, Attorney-in-Fact 2024-01-03