0001214659-22-007500.txt : 20220527 0001214659-22-007500.hdr.sgml : 20220527 20220527144539 ACCESSION NUMBER: 0001214659-22-007500 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20220526 FILED AS OF DATE: 20220527 DATE AS OF CHANGE: 20220527 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: 22976107 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-56342.xml PRIMARY DOCUMENT X0306 4 2022-05-26 0001761312 Palomar Holdings, Inc. PLMR 0001649289 Fallon Catriona M. 7979 IVANHOE AVENUE, SUITE 500 LA JOLLA CA 92037 true false false false Common Stock 2022-05-26 4 A false 963 0 A 3195 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 2022-05-26