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