Sec Form 4 Filing - Genstar VI GP AIV Ltd. @ Palomar Holdings, Inc. - 2020-01-14

Insider filing report for Changes in Beneficial Ownership
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FORM 4
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP
Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(h) of the Investment Company Act of 1940
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1. Name and Address of Reporting Person
Genstar VI GP AIV Ltd.
2. Issuer Name and Ticker or Trading Symbol
Palomar Holdings, Inc. [ PLMR]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
_____ Director X __ 10% Owner
_____ Officer (give title below) _____ Other (specify below)
(Last) (First) (Middle)
C/O GENSTAR CAPITAL LLC, FOUR EMBARCADERO CENTER, SUITE 1900
3. Date of Earliest Transaction (MM/DD/YY)
01/14/2020
(Street)
SAN FRANCISCO, CA94111
4. If Amendment, Date Original Filed (MM/DD/YY)
6. Individual or Joint/Group Filing (Check Applicable Line)
_____ Form filed by One Reporting Person
__ X __ Form filed by More than One Reporting Person
(City) (State) (Zip)
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
1.Title of Security
(Instr. 3)
2. Transaction Date (MM/DD/YY) 2A. Deemed Execution Date, if any (MM/DD/YY) 3. Transaction Code
(Instr. 8)
4. Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
5. Amount of Securities Beneficially Owned Following Reported Transaction(s)
(Instr. 3 and 4)
6. Ownership Form: Direct (D) or Indirect (I)
(Instr. 4)
7. Nature of Indirect Beneficial Ownership
(Instr. 4)
Code V Amount (A) or (D) Price
Common Stock 01/14/2020 S 1,269,900 ( 3 ) D $ 47.285 1,288,139 I See Footnotes ( 1 ) ( 2 ) ( 7 )
Common Stock 01/14/2020 S 2,963,100 ( 5 ) D $ 47.285 3,005,658 I See Footnotes ( 1 ) ( 4 ) ( 7 )
Common Stock 0 D ( 1 ) ( 6 ) ( 7 )
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
( e.g. , puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security
(Instr. 3)
2. Conversion or Exercise Price of Derivative Security 3. Transaction Date (MM/DD/YY) 3A. Deemed Execution Date, if any (MM/DD/YY) 4. Transaction Code
(Instr. 8)
5. Number of Derivative Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4, and 5)
6. Date Exercisable and Expiration Date
(MM/DD/YY)
7. Title and Amount of Underlying Securities
(Instr. 3 and 4)
8. Price of Derivative Security
(Instr. 5)
9. Number of Derivative Securities Beneficially Owned Following Reported Transaction(s)
(Instr. 4)
10. Ownership Form of Derivative Security: Direct (D) or Indirect (I)
(Instr. 4)
11. Nature of Indirect Beneficial Ownership
(Instr. 4)
Code V (A) (D) Date Exercisable Expiration Date Title Amount or Number of Shares
Reporting Owners
Reporting Owner Name / Address Relationships
Director 10% Owner Officer Other
Genstar VI GP AIV Ltd.
C/O GENSTAR CAPITAL LLC
FOUR EMBARCADERO CENTER, SUITE 1900
SAN FRANCISCO, CA94111
X
Genstar Capital VI AIV, L.P.
C/O GENSTAR CAPITAL LLC
FOUR EMBARCADERO CENTER, SUITE 1900
SAN FRANCISCO, CA94111
X
Genstar Capital Partners VI AIV, L.P.
C/O GENSTAR CAPITAL LLC
FOUR EMBARCADERO CENTER, SUITE 1900
SAN FRANCISCO, CA94111
X
Genstar Capital Partners VI AIV (DEL), L.P.
C/O GENSTAR CAPITAL LLC
FOUR EMBARCADERO CENTER, SUITE 1900
SAN FRANCISCO, CA94111
X
Stargen VI AIV, L.P.
C/O GENSTAR CAPITAL LLC
FOUR EMBARCADERO CENTER, SUITE 1900
SAN FRANCISCO, CA94111
X
Genstar V GP AIV Ltd.
C/O GENSTAR CAPITAL LLC
FOUR EMBARCADERO CENTER, SUITE 1900
SAN FRANCISCO, CA94111
X
Genstar Capital V AIV, L.P.
C/O GENSTAR CAPITAL LLC
FOUR EMBARCADERO CENTER, SUITE 1900
SAN FRANCISCO, CA94111
X
Genstar Capital Partners V AIV, L.P.
C/O GENSTAR CAPITAL LLC
FOUR EMBARCADERO CENTER, SUITE 1900
SAN FRANCISCO, CA94111
X
Stargen V AIV, L.P.
C/O GENSTAR CAPITAL LLC
FOUR EMBARCADERO CENTER, SUITE 1900
SAN FRANCISCO, CA94111
X
Clark James Ryan
C/O GENSTAR CAPITAL LLC
FOUR EMBARCADERO CENTER, SUITE 1900
SAN FRANCISCO, CA94111
X
Signatures
By: /s/ James Ryan Clark, Director 01/14/2020
Signature of Reporting Person Date
Explanation of Responses:
( 1 )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.
( 2 )Represents shares of Common Stock of the Issuer directly held by the following entities following the transaction: 1,193,383 shares held by Genstar VI; 49,341 shares held by Genstar VI DEL; and 45,415 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.
( 3 )Represents shares of common stock held directly and sold by the following entities: 1,176,486 shares sold by Genstar VI; 48,642 shares sold by Genstar VI DEL; and 44,772 shares sold by Stargen VI.
( 4 )Represents shares of Common Stock of the Issuer directly held by the following entities following the transaction: 2,918,114 shares held by Genstar V; and 87,544 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.
( 5 )Represents shares of common stock held directly and sold by the following entities: 2,876,796 shares sold by Genstar V; and 86,304 shares sold by Stargen V.
( 6 )James Ryan Clark is a director of each of Genstar VI Ltd. and Genstar V Ltd. and directly owns no shares of the Issuer.
( 7 )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.

Remarks:
Exhibit 99.1 (Joint Filer Information) is incorporated herein by reference.

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