0001104659-19-031460.txt : 20190523
0001104659-19-031460.hdr.sgml : 20190523
20190523161344
ACCESSION NUMBER: 0001104659-19-031460
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20190521
FILED AS OF DATE: 20190523
DATE AS OF CHANGE: 20190523
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Fallon Catriona M.
CENTRAL INDEX KEY: 0001649289
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-38873
FILM NUMBER: 19850196
MAIL ADDRESS:
STREET 1: C/O MARIN SOFTWARE INCORPORATED
STREET 2: 123 MISSION STREET, 25TH FLOOR
CITY: SAN FRANCISCO
STATE: CA
ZIP: 94105
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
a4.xml
4
X0306
4
2019-05-21
0
0001761312
Palomar Holdings, Inc.
PLMR
0001649289
Fallon Catriona M.
7979 IVANHOE AVENUE, SUITE 500
LA JOLLA
CA
92037
1
0
0
0
Common Stock (RSUs)
2019-05-21
4
A
0
1065
0
A
1065
D
Stock Option (right to buy)
23.46
2019-05-21
4
A
0
4262
0
A
2029-05-21
Common Stock
4262
4262
D
The Restricted Stock Units (RSUs) will vest in full on the first anniversary of the grant date.
Fifty percent (50%) of the option shares vest and become exercisable on May 21, 2020 and the remaining option shares vest and become exercisable in twelve (12) equal successive monthly installments thereafter.
/s/ Catriona M. Fallon
2019-05-23