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