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