0001722438-23-000028.txt : 20230228
0001722438-23-000028.hdr.sgml : 20230228
20230228181646
ACCESSION NUMBER: 0001722438-23-000028
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20230227
FILED AS OF DATE: 20230228
DATE AS OF CHANGE: 20230228
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Simkoff Maxwell
CENTRAL INDEX KEY: 0001868802
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-39754
FILM NUMBER: 23688276
MAIL ADDRESS:
STREET 1: 101 MISSION ST.
STREET 2: SUITE 740
CITY: SAN FRANCISCO
STATE: CA
ZIP: 94105
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Saslaw-Simkoff Revocable Trust
CENTRAL INDEX KEY: 0001875424
STATE OF INCORPORATION: CA
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-39754
FILM NUMBER: 23688275
BUSINESS ADDRESS:
STREET 1: 101 MISSION ST.
STREET 2: SUITE 740
CITY: SAN FRANCISCO
STATE: CA
ZIP: 94105
BUSINESS PHONE: 703-789-5646
MAIL ADDRESS:
STREET 1: 101 MISSION ST.
STREET 2: SUITE 740
CITY: SAN FRANCISCO
STATE: CA
ZIP: 94105
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: Doma Holdings, Inc.
CENTRAL INDEX KEY: 0001722438
STANDARD INDUSTRIAL CLASSIFICATION: TITLE INSURANCE [6361]
IRS NUMBER: 000000000
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 101 MISSION STREET
STREET 2: SUITE 740
CITY: SAN FRANCISCO
STATE: CA
ZIP: 94105
BUSINESS PHONE: (650) 419-3827
MAIL ADDRESS:
STREET 1: 101 MISSION STREET
STREET 2: SUITE 740
CITY: SAN FRANCISCO
STATE: CA
ZIP: 94105
FORMER COMPANY:
FORMER CONFORMED NAME: Capitol Investment Corp. V
DATE OF NAME CHANGE: 20171113
4
1
wf-form4_167762618701711.xml
FORM 4
X0306
4
2023-02-27
0
0001722438
Doma Holdings, Inc.
DOMA
0001868802
Simkoff Maxwell
101 MISSION ST.
SUITE 740
SAN FRANCISCO
CA
94105
1
1
1
0
Chief Executive Officer
0001875424
Saslaw-Simkoff Revocable Trust
101 MISSION ST.
SUITE 740
SAN FRANCISCO
CA
94105
0
0
1
0
Common stock
2023-02-27
4
G
0
346609
0
D
0
I
By Jennifer Saslaw 2020 GRAT
Common stock
2023-02-27
4
G
0
346609
0
D
0
I
By Max Simkoff 2020 GRAT
Common stock
2023-02-27
4
G
0
693218
0
A
46445530
I
By The Saslaw-Simkoff Revocable Trust
Common stock
2023-02-27
4
G
0
1411776
0
D
45033754
I
By The Saslaw-Simkoff Revocable Trust
Common stock
2023-02-27
4
G
0
705888
0
A
705888
I
By Jennifer Saslaw 2023 GRAT
Common stock
2023-02-27
4
G
0
705888
0
A
705888
I
By Maxwell Simkoff 2023 GRAT
Common stock
5219014
D
346,609 shares of Doma Holdings, Inc. (the "Company") common stock were previously owned by each of the Jennifer Saslaw 2020 GRAT and the Max Simkoff 2020 GRAT. These shares were distributed in the form of an annuity payment pursuant to the terms of the GRATS and subsequently transferred to The Saslaw-Simkoff Revocable Trust for no consideration.
These shares are held for the benefit of the reporting person's wife. The reporting person disclaims beneficial ownership of these shares except to the extent of his pecuniary interest therein.
These shares are owned directly by the Max Simkoff 2020 GRAT. The reporting person disclaims beneficial ownership except to the extent of his pecuniary interest therein.
These shares are owned directly by The Saslaw-Simkoff Revocable Trust and indirectly by Maxwell Simkoff as trustee of the trust. The reporting person disclaims beneficial ownership except to the extent of his pecuniary interest therein.
1,411,776 shares of Company common stock previously owned by The Saslaw-Simkoff Revocable Trust were contributed as follows: 705,888 shares were transferred to each of the Jennifer Saslaw 2023 GRAT and the Maxwell Simkoff 2023 GRAT for no consideration.
These shares are owned directly by the Maxwell Simkoff 2023 GRAT. The reporting person disclaims beneficial ownership except to the extent of his pecuniary interest therein.
/s/ Christian Ameri, as Attorney-in-Fact for Maxwell Simkoff
2023-02-28
/s/ Christian Ameri, as Attorney-in-Fact for Maxwell Simkoff, Trustee
2023-02-28