0001644548-18-000002.txt : 20180111 0001644548-18-000002.hdr.sgml : 20180111 20180111163734 ACCESSION NUMBER: 0001644548-18-000002 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20171010 FILED AS OF DATE: 20180111 DATE AS OF CHANGE: 20180111 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: 18523967 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 wf-form4_151570664034737.xml FORM 4 X0306 4 2017-10-10 0 0001502292 Conifer Holdings, Inc. CNFR 0001644548 Petcoff Nicholas J 550 W. MERRILL STREET SUITE 200 BIRMINGHAM MI 48009 1 1 0 0 EVP, Secretary Common Stock 2017-10-10 4 P 0 16000 6.25 A 114759 D Brian J. Roney, by Power of Attorney 2018-01-11