0001339147-16-000009.txt : 20160919 0001339147-16-000009.hdr.sgml : 20160919 20160919161646 ACCESSION NUMBER: 0001339147-16-000009 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20160915 FILED AS OF DATE: 20160919 DATE AS OF CHANGE: 20160919 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 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: MELOCHE HAROLD J CENTRAL INDEX KEY: 0001339147 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-37536 FILM NUMBER: 161891916 MAIL ADDRESS: STREET 1: 28819 FRANKLIN ROAD CITY: SOUTHFIELD STATE: MI ZIP: 48034 4 1 wf-form4_147431619349448.xml FORM 4 X0306 4 2016-09-15 0 0001502292 Conifer Holdings, Inc. CNFR 0001339147 MELOCHE HAROLD J 550 W. MERRILL STREET SUITE 200 BIRMINGHAM MI 48009 0 1 0 0 CFO, Treasurer Common Stock 2016-09-15 4 A 0 2448 8.17 A 41448 D Consists of restricted stock units, the shares underlying which will vest in annual increments of 20% beginning on the first anniversary of the date of grant, so that all of the shares will be vested on the five-year anniversary. Brian J. Roney, by Power of Attorney 2016-09-19