0001209191-22-030929.txt : 20220520
0001209191-22-030929.hdr.sgml : 20220520
20220520150853
ACCESSION NUMBER: 0001209191-22-030929
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20220519
FILED AS OF DATE: 20220520
DATE AS OF CHANGE: 20220520
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: PETCOFF JAMES G
CENTRAL INDEX KEY: 0001115666
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-37536
FILM NUMBER: 22947221
MAIL ADDRESS:
STREET 1: 350 N NINTH STREET
STREET 2: SUITE 202
CITY: BOISE
STATE: ID
ZIP: 83702
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: Conifer Holdings, Inc.
CENTRAL INDEX KEY: 0001502292
STANDARD INDUSTRIAL CLASSIFICATION: FIRE, MARINE & CASUALTY INSURANCE [6331]
IRS NUMBER: 271298795
STATE OF INCORPORATION: MI
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 550 WEST MERRILL STREET
STREET 2: SUITE 200
CITY: BIRMINGHAM
STATE: MI
ZIP: 48009
BUSINESS PHONE: (248) 559-0840
MAIL ADDRESS:
STREET 1: 550 WEST MERRILL STREET
STREET 2: SUITE 200
CITY: BIRMINGHAM
STATE: MI
ZIP: 48009
4
1
doc4.xml
FORM 4 SUBMISSION
X0306
4
2022-05-19
0
0001502292
Conifer Holdings, Inc.
CNFR
0001115666
PETCOFF JAMES G
550 W. MERRILL STREET
SUITE 200
BIRMINGHAM
MI
48009
1
1
1
0
Executive Chairman and Co-CEO
Common Stock
2022-05-19
4
P
0
3008
1.4993
A
24543
I
PH Real Estate, LLC.
Common Stock
2148607
I
James G. Petcoff Rev Trust
Common Stock
480275
D
This transaction was executed in multiple trades at prices ranging from $1.49 to $1.50. The price reported above reflects the weighted average purchase price. The reporting person hereby undertakes to provide upon request to the SEC staff, the issuer or a security holder of the issuer full information regarding the number of shares and prices at which the transaction was effected.
These shares are owned by PH Real Estate, LLC, a Michigan limited liability company. Mr. James G. Petcoff and his spouse have a majority interest in PH Real Estate, LLC and have the sole power to vote and dispose of all shares owned by PH Real Estate, LLC.
These shares are owned indirectly by Mr. Petcoff as trustee of the James G. Petcoff Revocable Trust. Mr. Petcoff is Chairman, CEO and a director of the issuer.
Brian J. Roney, by Power of Attorney
2022-05-20