0001214659-21-006177.txt : 20210601
0001214659-21-006177.hdr.sgml : 20210601
20210601164610
ACCESSION NUMBER: 0001214659-21-006177
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20210527
FILED AS OF DATE: 20210601
DATE AS OF CHANGE: 20210601
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: 21985981
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
marketforms-52966.xml
PRIMARY DOCUMENT
X0306
4
2021-05-27
0001761312
Palomar Holdings, Inc.
PLMR
0001649289
Fallon Catriona M.
7979 IVANHOE AVENUE, SUITE 500
LA JOLLA
CA
92037
true
false
false
false
Common Stock
2021-05-27
4
A
false
833
0
A
2232
D
The amount reported reflects Restricted Stock Units (RSUs) granted to the Reporting Person pursuant to Issuer's 2019 Equity Incentive Plan. Subject to the Reporting Person's continued service, the RSUs shall vest in full upon the first anniversary of the Grant Date.
Each restricted stock unit represents a contingent right to receive one share of the Issuer's common stock.
/s/ Christopher Uchida, Attorney-in-Fact
2021-06-01