0001209191-19-062223.txt : 20191231 0001209191-19-062223.hdr.sgml : 20191231 20191231135903 ACCESSION NUMBER: 0001209191-19-062223 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20191230 FILED AS OF DATE: 20191231 DATE AS OF CHANGE: 20191231 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Petcoff Nicholas J CENTRAL INDEX KEY: 0001644548 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-37536 FILM NUMBER: 191319047 MAIL ADDRESS: STREET 1: 550 W. MERRILL STREET STREET 2: SUITE 200 CITY: BIRMINGHAM STATE: MI ZIP: 48009 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 2019-12-30 0 0001502292 Conifer Holdings, Inc. CNFR 0001644548 Petcoff Nicholas J 550 WEST MERRILL STREET SUITE 200 BIRMINGHAM MI 48009 1 1 0 0 EVP, Secretary Common Stock 2019-12-30 4 P 0 5000 4.00 A 175314 D Brian J Roney, by Power of Attorney 2019-12-31