UNITED STATES
SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
SCHEDULE 13D
Under the Securities Exchange Act of 1934
(Amendment No. 8)*
Conifer Holdings, Inc.
(Name of Issuer)
Common Stock, no par value
(Title of Class of Securities)
20731J102
(CUSIP Number)
Conifer Holdings, Inc.
3001 West Big Beaver Road, Suite 200
Troy, MI 48084
(248) 559-0840
(Name, Address and Telephone Number of Person Authorized to Receive Notices and Communications)
December 18, 2023
(Date of Event Which Requires Filing of this Statement)
If the filing person has previously filed a statement on Schedule 13G to report the acquisition that is the subject of this Schedule 13D, and is filing this schedule because of §§ 240.13d-1(e), 240.13d-1(f) or 240.13d-1(g), check the following box. ☐
Note: Schedules filed in paper format shall include a signed original and five copies of the schedule, including all exhibits. See Rule 13d-7 for other parties to whom copies are to be sent.
* The remainder of this cover page shall be filled out for a reporting person’s initial filing on this form with respect to the subject class of securities, and for any subsequent amendment containing information which would alter disclosures provided in a prior cover page.
The information required on the remainder of this cover page shall not be deemed to be “filed” for the purpose of section 18 of the Securities Exchange Act of 1934 (“Act”) or otherwise subject to the liabilities of that section of the Act but shall be subject to all other provisions of the Act (however, see the Notes).
SCHEDULE 13D
CUSIP No. 20731J102 |
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Page 2 of NUMPAGES \* MERGEFORMAT 7 |
(1) |
Names of reporting persons
James G. Petcoff |
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(2) |
Check the appropriate box if a member of a group (see instructions)
(a) ☐ (b) ☒ |
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(3) |
SEC use only
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(4) |
Source of funds (see instructions)
PF |
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(5) |
Check if disclosure of legal proceedings is required pursuant to Items 2(d) or 2(e)
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(6) |
Citizenship or place of organization
United States of America |
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Number of |
(7) |
Sole voting power
3,437,647 |
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shares beneficially owned by |
(8) |
Shared voting power
0 |
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each reporting person |
(9) |
Sole dispositive power
3,437,647 |
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with: |
(10) |
Shared dispositive power
0 |
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(11) |
Aggregate amount beneficially owned by each reporting person
3,437,647 |
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(12) |
Check if the aggregate amount in Row (11) excludes certain shares (see instructions)
☐
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(13) |
Percent of class represented by amount in Row (11)
28.1% |
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(14) |
Type of reporting person (see instructions)
IN |
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SCHEDULE 13D
CUSIP No. 20731J102 |
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Page 3 of NUMPAGES \* MERGEFORMAT 7 |
Item 1. Security and Issuer
This Schedule 13D is being filed with respect to shares of Common Stock issued by Conifer Holdings, Inc., whose principal executive offices are at 3001 West Big Beaver Road, Suite 200, Troy, MI 48084.
Item 2. Identity and Background
Item 3. Source and Amount of Funds or Other Considerations
Not applicable.
Item 4. Purpose of Transaction
Not applicable.
Item 5. Interest in Securities of the Issuer
Item 6. Contracts, Arrangements, Understandings or Relationships with Respect to Securities of the Issuer
On December 18, 2023, James G. Petcoff, Nicholas J. Petcoff, and Andrew Petcoff terminated the voting agreement they entered into on August 8, 2022.
Item 7. Material to be Filed as Exhibits
SCHEDULE 13D
CUSIP No. 20731J102 |
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Page 4 of NUMPAGES \* MERGEFORMAT 7 |
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Exhibit Number |
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Exhibit Description |
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9.1 |
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SIGNATURE
After reasonable inquiry and to the best of my knowledge and belief, I certify that the information set forth in this statement is true, complete and correct.
Date: December 22, 2023 |
Signature: /s/ James G. Petcoff |
Name/Title: James G. Petcoff, Executive Chairman and Co-Chief Executive Officer |