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