0000905729-23-000187.txt : 20231222 0000905729-23-000187.hdr.sgml : 20231222 20231222140856 ACCESSION NUMBER: 0000905729-23-000187 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20231220 FILED AS OF DATE: 20231222 DATE AS OF CHANGE: 20231222 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Hakala Jeffrey Anthony CENTRAL INDEX KEY: 0001735480 ORGANIZATION NAME: FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-37536 FILM NUMBER: 231509093 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] ORGANIZATION NAME: 02 Finance IRS NUMBER: 271298795 STATE OF INCORPORATION: MI FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 3001 WEST BIG BEAVER ROAD STREET 2: SUITE 200 CITY: TROY STATE: MI ZIP: 48084 BUSINESS PHONE: (248) 559-0840 MAIL ADDRESS: STREET 1: 3001 WEST BIG BEAVER ROAD STREET 2: SUITE 200 CITY: TROY STATE: MI ZIP: 48084 4 1 ownership.xml X0508 4 2023-12-20 0 0001502292 Conifer Holdings, Inc. CNFR 0001735480 Hakala Jeffrey Anthony 550 WEST MERRILL STREET, SUITE 200 BIRMINGHAM MI 48009 1 0 0 0 0 Series A Preferred Stock 2023-12-20 4 P 0 1000 6000.00 A 1000 I Held by Clarkson 91 West, LLC Common Stock 3635769 I Held by Clarkson Ventures, LLC The shares are held directly by Clarkston 91 West, LLC ("C91") and indirectly by Mr. Hakala as a shareholder of the parent company of C91. Mr. Hakala disclaims beneficial ownership in the shares held by C91 except to the extent of his pecuniary ownership therein. 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. /s/ Jeffrey A. Hakala 2023-12-22