ANNUAL REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934
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TRANSITION REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934
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(State or other jurisdiction of incorporation or organization)
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(I.R.S. Employer Identification No.)
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(Address of principal executive offices)
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(Zip code)
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Title of each class
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Trading Symbol(s)
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Name of each exchange on which registered
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The
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The
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Large accelerated filer ☐
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Accelerated filer ☐
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Smaller reporting company
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Emerging growth company
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Auditor Name:
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Auditor Location:
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PCAOB ID No.
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Page No.
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Part III
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Items 12.
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3
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Part IV
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Item 15.
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5
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6
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ITEM 12. |
SECURITY OWNERSHIP OF CERTAIN BENEFICIAL OWNERS AND MANAGEMENT AND RELATED STOCKHOLDER MATTERS
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each of our directors and nominees for director;
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each of our named executive officers;
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all of our current directors and named executive officers as a group; and
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each person or group, who beneficially owned more than 5% of our common stock.
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Name of Beneficial Owner
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Number of
Shares
Beneficially
Owned
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Number
of Shares
of
Series B
Preferred
Stock
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Percentage
of Shares
Beneficially
Owned (1)
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Named Executive Officers and Directors:
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Brian Roney (2)
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634,232
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4.0
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%
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Harold Meloche (3)
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88,588
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*
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Timothy Lamothe
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17,351
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*
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Joseph Sarafa
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350,000
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2.4
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%
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R. Jamison Williams, Jr.
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440,752
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3.0
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%
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Isolde O'Hanlon
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5,000
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*
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John Melstrom
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25,000
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*
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Jeffrey Hakala (4)
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3,735,769 |
1,500 (2,443,353 votes)
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42.1
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%
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Gerald Hakala (4)
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3,735,769
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1,500 (2,443,353 votes)
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42.1 |
%
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J. Grant Smith
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—
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—
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*
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Nicholas Petcoff (5)
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275,314
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1.9
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% |
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All named executive officers and directors as a group (10 persons) (6)
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5,124,193
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1,500 (2,443,353 votes)
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50.9
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%
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Other Beneficial Owners
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Clarkston Ventures, LLC (7)
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3,735,769
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1,500 (2,443,353 votes)
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42.1
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%
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James Petcoff (8)
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3,437,647
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23.5
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%
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Incorporated by Reference
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Exhibit
Number
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Exhibit Description
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Form
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Period
Ending
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Exhibit /
Appendix
Number
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Filing Date
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Filed /
Furnished Herewith
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Section 302 Certification — CEO
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Section 302 Certification — CFO
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101.INS
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inline XBRL Instance Document
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101.DEF
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Inline XBRL Taxonomy Extension Definition Linkbase Document
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101.LAB
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Inline XBRL Taxonomy Extension Label Linkbase Document
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101.PRE
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Inline XBRL Taxonomy Extension Presentation Linkbase Document
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101.SCH
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inline XBRL Taxonomy Extension Schema With Embedded Linkbases Document
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*
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104
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Cover Page Interactive Data file (embedded within the inline XBRL document)
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CONIFER HOLDINGS, INC.
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By:
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/s/ Brian J. Roney
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Brian J. Roney
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Chief Executive Officer
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(Principal Executive Officer)
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By:
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/s/ Harold J. Meloche
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Harold J. Meloche
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Chief Financial Officer and Treasurer
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(Principal Accounting and Financial Officer)
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Dated: May 9, 2025 |