0001735480-19-000005.txt : 20190702 0001735480-19-000005.hdr.sgml : 20190702 20190702142908 ACCESSION NUMBER: 0001735480-19-000005 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20190313 FILED AS OF DATE: 20190702 DATE AS OF CHANGE: 20190702 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Hakala Jeffrey Anthony CENTRAL INDEX KEY: 0001735480 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-37536 FILM NUMBER: 19936620 MAIL ADDRESS: STREET 1: 91 WEST LONG LAKE ROAD CITY: BLOOMFIELD HILLS STATE: MI ZIP: 48304 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 wf-form4_156209213359189.xml FORM 4 X0306 4 2019-03-13 0 0001502292 Conifer Holdings, Inc. CNFR 0001735480 Hakala Jeffrey Anthony 550 W. MERRILL STREET SUITE 200 BIRMINGHAM MI 48009 1 0 0 0 Common Stock 2019-03-13 4 P 0 39056 4 A 254137 I Held by Clarkston Ventures, LLC Common Stock 2019-03-13 4 P 0 1627 3.999 A 255764 I Held by Clarkston Ventures, LLC Common Stock 2019-03-15 4 P 0 208 3.90 A 255972 I Held by Clarkston Ventures, LLC Common Stock 2019-06-24 4 J 0 7683 6.40 A 263655 I Held by Clarkston Ventures, LLC Common Stock 2019-06-28 4 P 0 504506 4.25 A 768161 I Held by Clarkston Ventures, LLC The shares are held directly by Clarkston Ventures, LLC ("CV") and indirectly by Mr. Hakala as the managing partner of CV. Mr. Hakala disclaims beneficial ownership in the shares held by CV except to the extent of his pecuniary ownership therein. Mr. Hakala acquired 7,683 shares through an in-kind redemption that increased his ownership in CV. Brian J. Roney, by Power of Attorney 2019-07-02