0001104659-19-052100.txt : 20190930 0001104659-19-052100.hdr.sgml : 20190930 20190930185244 ACCESSION NUMBER: 0001104659-19-052100 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 2 CONFORMED PERIOD OF REPORT: 20190930 FILED AS OF DATE: 20190930 DATE AS OF CHANGE: 20190930 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Clark James Ryan CENTRAL INDEX KEY: 0001772377 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38873 FILM NUMBER: 191127207 MAIL ADDRESS: STREET 1: 7979 IVANHOE AVENUE STREET 2: SUITE 500 CITY: LA JOLLA STATE: CA ZIP: 92037 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Stargen V AIV, LP CENTRAL INDEX KEY: 0001772626 STATE OF INCORPORATION: E9 FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38873 FILM NUMBER: 191127208 BUSINESS ADDRESS: STREET 1: FOUR EMBARCADERO CENTER STREET 2: SUITE 1900 CITY: SAN FRANCISCO STATE: CA ZIP: 94111 BUSINESS PHONE: 415-834-2360 MAIL ADDRESS: STREET 1: FOUR EMBARCADERO CENTER STREET 2: SUITE 1900 CITY: SAN FRANCISCO STATE: CA ZIP: 94111 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Genstar Capital Partners V AIV, L.P. CENTRAL INDEX KEY: 0001772560 STATE OF INCORPORATION: E9 FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38873 FILM NUMBER: 191127209 BUSINESS ADDRESS: STREET 1: FOUR EMBARCADERO CENTER STREET 2: SUITE 1900 CITY: SAN FRANCISCO STATE: CA ZIP: 94111 BUSINESS PHONE: 415-834-2360 MAIL ADDRESS: STREET 1: FOUR EMBARCADERO CENTER STREET 2: SUITE 1900 CITY: SAN FRANCISCO STATE: CA ZIP: 94111 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Genstar Capital V AIV, L.P. CENTRAL INDEX KEY: 0001772561 STATE OF INCORPORATION: E9 FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38873 FILM NUMBER: 191127210 BUSINESS ADDRESS: STREET 1: FOUR EMBARCADERO CENTER STREET 2: SUITE 1900 CITY: SAN FRANCISCO STATE: CA ZIP: 94111 BUSINESS PHONE: 415-834-2360 MAIL ADDRESS: STREET 1: FOUR EMBARCADERO CENTER STREET 2: SUITE 1900 CITY: SAN FRANCISCO STATE: CA ZIP: 94111 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Genstar V GP AIV LTD. CENTRAL INDEX KEY: 0001772563 STATE OF INCORPORATION: E9 FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38873 FILM NUMBER: 191127211 BUSINESS ADDRESS: STREET 1: FOUR EMBARCADERO CENTER STREET 2: SUITE 1900 CITY: SAN FRANCISCO STATE: CA ZIP: 94111 BUSINESS PHONE: 415-834-2360 MAIL ADDRESS: STREET 1: FOUR EMBARCADERO CENTER STREET 2: SUITE 1900 CITY: SAN FRANCISCO STATE: CA ZIP: 94111 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Stargen VI AIV, LP CENTRAL INDEX KEY: 0001772628 STATE OF INCORPORATION: E9 FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38873 FILM NUMBER: 191127212 BUSINESS ADDRESS: STREET 1: FOUR EMBARCADERO CENTER STREET 2: SUITE 1900 CITY: SAN FRANCISCO STATE: CA ZIP: 94111 BUSINESS PHONE: 415-834-2360 MAIL ADDRESS: STREET 1: FOUR EMBARCADERO CENTER STREET 2: SUITE 1900 CITY: SAN FRANCISCO STATE: CA ZIP: 94111 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Genstar Capital Partners VI AIV (DEL), L.P. CENTRAL INDEX KEY: 0001772557 STATE OF INCORPORATION: E9 FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38873 FILM NUMBER: 191127213 BUSINESS ADDRESS: STREET 1: FOUR EMBARCADERO CENTER STREET 2: SUITE 1900 CITY: SAN FRANCISCO STATE: CA ZIP: 94111 BUSINESS PHONE: 415-834-2360 MAIL ADDRESS: STREET 1: FOUR EMBARCADERO CENTER STREET 2: SUITE 1900 CITY: SAN FRANCISCO STATE: CA ZIP: 94111 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Genstar Capital Partners VI AIV, L.P. CENTRAL INDEX KEY: 0001772559 STATE OF INCORPORATION: E9 FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38873 FILM NUMBER: 191127214 BUSINESS ADDRESS: STREET 1: FOUR EMBARCADERO CENTER STREET 2: SUITE 1900 CITY: SAN FRANCISCO STATE: CA ZIP: 94111 BUSINESS PHONE: 415-834-2360 MAIL ADDRESS: STREET 1: FOUR EMBARCADERO CENTER STREET 2: SUITE 1900 CITY: SAN FRANCISCO STATE: CA ZIP: 94111 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Genstar Capital VI AIV, L.P. CENTRAL INDEX KEY: 0001772562 STATE OF INCORPORATION: E9 FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38873 FILM NUMBER: 191127215 BUSINESS ADDRESS: STREET 1: FOUR EMBARCADERO CENTER STREET 2: SUITE 1900 CITY: SAN FRANCISCO STATE: CA ZIP: 94111 BUSINESS PHONE: 415-834-2360 MAIL ADDRESS: STREET 1: FOUR EMBARCADERO CENTER STREET 2: SUITE 1900 CITY: SAN FRANCISCO STATE: CA ZIP: 94111 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Genstar VI GP AIV LTD. CENTRAL INDEX KEY: 0001772564 STATE OF INCORPORATION: E9 FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38873 FILM NUMBER: 191127216 BUSINESS ADDRESS: STREET 1: FOUR EMBARCADERO CENTER STREET 2: SUITE 1900 CITY: SAN FRANCISCO STATE: CA ZIP: 94111 BUSINESS PHONE: 415-834-2360 MAIL ADDRESS: STREET 1: FOUR EMBARCADERO CENTER STREET 2: SUITE 1900 CITY: SAN FRANCISCO STATE: CA ZIP: 94111 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 2019-09-30 0 0001761312 Palomar Holdings, Inc. PLMR 0001772564 Genstar VI GP AIV LTD. C/O GENSTAR CAPITAL LLC FOUR EMBARCADERO CENTER, SUITE 1900 SAN FRANCISCO CA 94111 0 0 1 0 0001772562 Genstar Capital VI AIV, L.P. C/O GENSTAR CAPITAL LLC FOUR EMBARCADERO CENTER, SUITE 1900 SAN FRANCISCO CA 94111 0 0 1 0 0001772559 Genstar Capital Partners VI AIV, L.P. C/O GENSTAR CAPITAL LLC FOUR EMBARCADERO CENTER, SUITE 1900 SAN FRANCISCO CA 94111 0 0 1 0 0001772557 Genstar Capital Partners VI AIV (DEL), L.P. C/O GENSTAR CAPITAL LLC FOUR EMBARCADERO CENTER, SUITE 1900 SAN FRANCISCO CA 94111 0 0 1 0 0001772628 Stargen VI AIV, LP C/O GENSTAR CAPITAL LLC FOUR EMBARCADERO CENTER, SUITE 1900 SAN FRANCISCO CA 94111 0 0 1 0 0001772563 Genstar V GP AIV LTD. C/O GENSTAR CAPITAL LLC FOUR EMBARCADERO CENTER, SUITE 1900 SAN FRANCISCO CA 94111 0 0 1 0 0001772561 Genstar Capital V AIV, L.P. C/O GENSTAR CAPITAL LLC FOUR EMBARCADERO CENTER, SUITE 1900 SAN FRANCISCO CA 94111 0 0 1 0 0001772560 Genstar Capital Partners V AIV, L.P. C/O GENSTAR CAPITAL LLC FOUR EMBARCADERO CENTER, SUITE 1900 SAN FRANCISCO CA 94111 0 0 1 0 0001772626 Stargen V AIV, LP C/O GENSTAR CAPITAL LLC FOUR EMBARCADERO CENTER, SUITE 1900 SAN FRANCISCO CA 94111 0 0 1 0 0001772377 Clark James Ryan C/O GENSTAR CAPITAL LLC FOUR EMBARCADERO CENTER, SUITE 1900 SAN FRANCISCO CA 94111 1 0 0 0 Common Stock 2019-09-30 4 S 0 1546050 35.04 D 2794289 I See Footnotes Common Stock 2019-09-30 4 S 0 3607450 35.04 D 6520008 I See Footnotes Common Stock 0 D This report is filed by the following Reporting Persons: Genstar VI GP AIV Ltd. ("Genstar VI Ltd."); Genstar Capital VI AIV, L.P. ("Genstar VI GP"); Genstar Capital Partners VI AIV, L.P. ("Genstar VI"); Genstar Capital Partners VI AIV (DEL), L.P. ("Genstar VI DEL"); Stargen VI AIV, L.P. ("Stargen VI"); Genstar V GP AIV Ltd. ("Genstar V Ltd."); Genstar Capital V AIV, L.P. ("Genstar V GP"); Genstar Capital Partners V AIV, L.P. ("Genstar V"); Stargen V AIV, L.P. ("Stargen V"); and James Ryan Clark. Represents shares of Common Stock of the Issuer directly held by the following entities following the transaction: 2,588,740 shares held by Genstar VI; 107,033 shares held by Genstar VI DEL; and 98,516 shares held by Stargen VI. Genstar VI Ltd. is the general partner of Genstar VI GP, which in turn is the general partner of each of Genstar VI, Genstar VI DEL and Stargen VI. Represents shares of common stock held directly and sold by the following entities: 1,432,322 shares sold by Genstar VI; 59,221 shares sold by Genstar VI DEL; and 54,507 shares sold by Stargen VI. Represents shares of Common Stock of the Issuer directly held by the following entities following the transaction: 6,330,104 shares held by Genstar V; and 189,904 shares held by Stargen V. Genstar V Ltd. is the general partner of Genstar V GP, which in turn is the general partner of each of Genstar V and Stargen V. Represents shares of common stock held directly and sold by the following entities: 3,502,379 shares sold by Genstar V; and 105,071 shares sold by Stargen V. James Ryan Clark is a director of each of Genstar VI Ltd. and Genstar V Ltd. and directly owns no shares of the Issuer. This filing shall not be deemed an admission that for purposes of Section 16 of the Securities Exchange Act of 1934, as amended, or otherwise, that the Reporting Persons are the beneficial owners of any equity securities in excess of their respective pecuniary interests, and each Reporting Person disclaims beneficial ownership of the securities reported herein, except to the extent of such Reporting Person's pecuniary interest therein, if any. Exhibit 99.1 (Joint Filer Information) is incorporated herein by reference. By: /s/ James Ryan Clark, Director 2019-09-30 EX-99.1 2 ex-99d1.htm EX-99.1

Exhibit 99.1

 

Joint Filer Information

 

Name of Joint Filer:

 

Genstar Capital VI AIV, L.P.

 

 

 

Address of Joint Filer:

 

c/o Genstar Capital LLC

 

 

Four Embarcadero Center, Suite 1900

 

 

San Francisco, CA 94111

 

 

 

Relationship of Joint Filer to Issuer:

 

10% Owner

 

 

 

Issuer Name and Ticker or Trading Symbol:

 

Palomar Holdings, Inc. [PLMR]

 

 

 

Date of Event Requiring Statement

 

 

(Month/Day/Year):

 

September 30, 2019

 

 

 

Designated Filer:

 

Genstar VI GP AIV Ltd.

 

Signature:

 

 

 

GENSTAR CAPITAL VI AIV, L.P.

 

By: GENSTAR VI GP AIV LTD., its General Partner

 

 

 

 

 

By:

/s/James Ryan Clark

 

 

Name: James Ryan Clark

 

 

Title: Director

 

 

 

 

 

Dated: September 30, 2019

 

 

 

Joint Filer Information

 

(continued)

 

Name of Joint Filer:

 

Genstar Capital Partners VI AIV, L.P.

 

 

 

Address of Joint Filer:

 

c/o Genstar Capital LLC

 

 

Four Embarcadero Center, Suite 1900

 

 

San Francisco, CA 94111

 

 

 

Relationship of Joint Filer to Issuer:

 

10% Owner

 

 

 

Issuer Name and Ticker or Trading Symbol:

 

Palomar Holdings, Inc. [PLMR]

 

 

 

Date of Event Requiring Statement

 

 

(Month/Day/Year):

 

September 30, 2019

 

 

 

Designated Filer:

 

Genstar VI GP AIV Ltd.

 

Signature:

 

 

 

GENSTAR CAPITAL PARTNERS VI AIV, L.P.

 

By: GENSTAR CAPITAL VI AIV, L.P., its General Partner

 

By: GENSTAR VI GP AIV LTD., its General Partner

 

 

 

 

 

By:

/s/James Ryan Clark

 

 

Name: James Ryan Clark

 

 

Title: Director

 

 

 

 

 

Dated: September 30, 2019

 

 

2

 

Joint Filer Information

 

(continued)

 

Name of Joint Filer:

 

Genstar Capital Partners VI AIV (DEL), L.P.

 

 

 

Address of Joint Filer:

 

c/o Genstar Capital LLC

 

 

Four Embarcadero Center, Suite 1900

 

 

San Francisco, CA 94111

 

 

 

Relationship of Joint Filer to Issuer:

 

10% Owner

 

 

 

Issuer Name and Ticker or Trading Symbol:

 

Palomar Holdings, Inc. [PLMR]

 

 

 

Date of Event Requiring Statement

 

 

(Month/Day/Year):

 

September 30, 2019

 

 

 

Designated Filer:

 

Genstar VI GP AIV Ltd.

 

Signature:

 

 

 

GENSTAR CAPITAL PARTNERS VI AIV (DEL), L.P.

 

By: GENSTAR CAPITAL VI AIV, L.P., its General Partner

 

By: GENSTAR VI GP AIV LTD., its General Partner

 

 

 

 

 

By:

/s/James Ryan Clark

 

 

Name: James Ryan Clark

 

 

Title: Director

 

 

 

 

 

Dated: September 30, 2019

 

 

3

 

Joint Filer Information

 

(continued)

 

Name of Joint Filer:

 

Stargen VI AIV, L.P.

 

 

 

Address of Joint Filer:

 

c/o Genstar Capital LLC

 

 

Four Embarcadero Center, Suite 1900

 

 

San Francisco, CA 94111

 

 

 

Relationship of Joint Filer to Issuer:

 

10% Owner

 

 

 

Issuer Name and Ticker or Trading Symbol:

 

Palomar Holdings, Inc. [PLMR]

 

 

 

Date of Event Requiring Statement

 

 

(Month/Day/Year):

 

September 30, 2019

 

 

 

Designated Filer:

 

Genstar VI GP AIV Ltd.

 

Signature:

 

 

 

STARGEN VI AIV, L.P.

 

By: GENSTAR CAPITAL VI AIV, L.P., its General Partner

 

By: GENSTAR VI GP AIV LTD., its General Partner

 

 

 

 

 

 

By:

/s/James Ryan Clark

 

 

Name: James Ryan Clark

 

 

Title: Director

 

 

 

 

 

Dated: September 30, 2019

 

 

4

 

Joint Filer Information

 

(continued)

 

Name of Joint Filer:

 

Genstar V GP AIV Ltd.

 

 

 

Address of Joint Filer:

 

c/o Genstar Capital LLC

 

 

Four Embarcadero Center, Suite 1900

 

 

San Francisco, CA 94111

 

 

 

Relationship of Joint Filer to Issuer:

 

10% Owner

 

 

 

Issuer Name and Ticker or Trading Symbol:

 

Palomar Holdings, Inc. [PLMR]

 

 

 

Date of Event Requiring Statement

 

 

(Month/Day/Year):

 

September 30, 2019

 

 

 

Designated Filer:

 

Genstar VI GP AIV Ltd.

 

Signature:

 

 

 

GENSTAR V GP AIV LTD.

 

 

 

 

 

 

By:

/s/James Ryan Clark

 

 

Name: James Ryan Clark

 

 

Title: Director

 

 

 

 

 

Dated: September 30, 2019

 

 

5

 

Joint Filer Information

 

(continued)

 

Name of Joint Filer:

 

Genstar Capital V AIV, L.P.

 

 

 

Address of Joint Filer:

 

c/o Genstar Capital LLC

 

 

Four Embarcadero Center, Suite 1900

 

 

San Francisco, CA 94111

 

 

 

Relationship of Joint Filer to Issuer:

 

10% Owner

 

 

 

Issuer Name and Ticker or Trading Symbol:

 

Palomar Holdings, Inc. [PLMR]

 

 

 

Date of Event Requiring Statement

 

 

(Month/Day/Year):

 

September 30, 2019

 

 

 

Designated Filer:

 

Genstar VI GP AIV Ltd.

 

Signature:

 

 

 

GENSTAR CAPITAL V AIV, L.P.

 

By: GENSTAR V GP AIV LTD., its General Partner

 

 

 

 

 

By:

/s/James Ryan Clark

 

 

Name: James Ryan Clark

 

 

Title: Director

 

 

 

 

 

Dated: September 30, 2019

 

 

6

 

Joint Filer Information

 

(continued)

 

Name of Joint Filer:

 

Genstar Capital Partners V AIV, L.P.

 

 

 

Address of Joint Filer:

 

c/o Genstar Capital LLC

 

 

Four Embarcadero Center, Suite 1900

 

 

San Francisco, CA 94111

 

 

 

Relationship of Joint Filer to Issuer:

 

10% Owner

 

 

 

Issuer Name and Ticker or Trading Symbol:

 

Palomar Holdings, Inc. [PLMR]

 

 

 

Date of Event Requiring Statement

 

 

(Month/Day/Year):

 

September 30, 2019

 

 

 

Designated Filer:

 

Genstar VI GP AIV Ltd.

 

Signature:

 

 

 

GENSTAR CAPITAL PARTNERS V AIV, L.P.

 

By: GENSTAR CAPITAL V AIV, L.P., its General Partner

 

By: GENSTAR V GP AIV LTD., its General Partner

 

 

 

 

 

By:

/s/James Ryan Clark

 

 

Name: James Ryan Clark

 

 

Title: Director

 

 

 

 

 

Dated: September 30, 2019

 

 

7

 

Joint Filer Information

 

(continued)

 

Name of Joint Filer:

 

Stargen V AIV, L.P.

 

 

 

Address of Joint Filer:

 

c/o Genstar Capital LLC

 

 

Four Embarcadero Center, Suite 1900

 

 

San Francisco, CA 94111

 

 

 

Relationship of Joint Filer to Issuer:

 

10% Owner

 

 

 

Issuer Name and Ticker or Trading Symbol:

 

Palomar Holdings, Inc. [PLMR]

 

 

 

Date of Event Requiring Statement

 

 

(Month/Day/Year):

 

September 30, 2019

 

 

 

Designated Filer:

 

Genstar VI GP AIV Ltd.

 

Signature:

 

 

 

STARGEN V AIV, L.P.

 

By: GENSTAR CAPITAL V AIV, L.P., its General Partner

 

By: GENSTAR V GP AIV LTD., its General Partner

 

 

 

 

 

By:

/s/James Ryan Clark

 

 

Name: James Ryan Clark

 

 

Title: Director

 

 

 

 

 

Dated: September 30, 2019

 

 

8

 

Joint Filer Information

 

(continued)

 

Name of Joint Filer:

 

James Ryan Clark

 

 

 

Address of Joint Filer:

 

c/o Genstar Capital LLC

 

 

Four Embarcadero Center, Suite 1900

 

 

San Francisco, CA 94111

 

 

 

Relationship of Joint Filer to Issuer:

 

Director

 

 

 

Issuer Name and Ticker or Trading Symbol:

 

Palomar Holdings, Inc. [PLMR]

 

 

 

Date of Event Requiring Statement

 

 

(Month/Day/Year):

 

September 30, 2019

 

 

 

Designated Filer:

 

Genstar VI GP AIV Ltd.

 

Signature:

 

 

 

 

 

/s/James Ryan Clark

 

James Ryan Clark

 

 

 

 

 

Dated: September 30, 2019

 

 

9