0001214659-21-011385.txt : 20211110 0001214659-21-011385.hdr.sgml : 20211110 20211110131451 ACCESSION NUMBER: 0001214659-21-011385 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20211108 FILED AS OF DATE: 20211110 DATE AS OF CHANGE: 20211110 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Notaras Martha CENTRAL INDEX KEY: 0001803071 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38873 FILM NUMBER: 211395732 MAIL ADDRESS: STREET 1: 7979 IVANHOE AVENUE, SUITE 500 CITY: LA JOLLA STATE: CA ZIP: 92037 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-54197.xml PRIMARY DOCUMENT X0306 4 2021-11-08 0001761312 Palomar Holdings, Inc. PLMR 0001803071 Notaras Martha 7979 IVANHOE AVENUE, SUITE 500 LA JOLLA CA 92037 true false false false Common Stock 2021-11-08 4 P false 1587 94.3315 A 3229 D The amount reported includes 833 Restricted Stock Units (RSUs) granted to the Reporting Person pursuant to the Issuer's 2019 Equity Incentive Plan (the "Plan"), which shall vest in full upon the first anniversary of the Grant Date subject to the Reporting Person's continuing Service (as defined in the Plan) with the Issuer. /s/ Christopher Uchida, Attorney-in-Fact 2021-11-10