0001104659-20-068547.txt : 20200601 0001104659-20-068547.hdr.sgml : 20200601 20200601191948 ACCESSION NUMBER: 0001104659-20-068547 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20200528 FILED AS OF DATE: 20200601 DATE AS OF CHANGE: 20200601 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: 20935257 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 2020-05-28 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) 2020-05-28 4 A 0 334 0 A 1399 D The amount reported reflects Restricted Stock Units (RSUs) granted to the Reporting Person pursuant to the Issuer's 2019 Equity Incentive Plan (the "Plan"), which shall vest upon the earlier of (i) the twelve month anniversary of the "Grant Date/Vesting Base Date" and (ii) immediately prior to the Issuer's 2021 Annual Meeting, subject to the Reporting Person's continuing Service (as defined in the Plan) with the Issuer. /s/ Christopher Uchida, Attorney-in-Fact 2020-05-29