-----BEGIN PRIVACY-ENHANCED MESSAGE----- Proc-Type: 2001,MIC-CLEAR Originator-Name: webmaster@www.sec.gov Originator-Key-Asymmetric: MFgwCgYEVQgBAQICAf8DSgAwRwJAW2sNKK9AVtBzYZmr6aGjlWyK3XmZv3dTINen TWSM7vrzLADbmYQaionwg5sDW3P6oaM5D3tdezXMm7z1T+B+twIDAQAB MIC-Info: RSA-MD5,RSA, PeZDQe4nA/8REjUODfmKX2jWDK1dZLG+Z4sFsTCW8yOgorDRxBjD6tXXN1hG3Pip /gYrjLzbRhI87h8hjT6lfA== 0000904454-05-000433.txt : 20051117 0000904454-05-000433.hdr.sgml : 20051117 20051117162547 ACCESSION NUMBER: 0000904454-05-000433 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20051117 FILED AS OF DATE: 20051117 DATE AS OF CHANGE: 20051117 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: WELSH CARSON ANDERSON & STOWE VII LP ET AL CENTRAL INDEX KEY: 0001012089 STATE OF INCORPORATION: DE FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-12251 FILM NUMBER: 051212971 BUSINESS ADDRESS: STREET 1: 320 PARK AVENUE STREET 2: SUITE 2500 CITY: NEW YORK STATE: NY ZIP: 10022 MAIL ADDRESS: STREET 1: 320 PARK AVENUE STREET 2: SUITE 2500 CITY: NEW YORK STATE: NY ZIP: 10022 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: AMERISAFE INC CENTRAL INDEX KEY: 0001018979 STANDARD INDUSTRIAL CLASSIFICATION: FIRE, MARINE & CASUALTY INSURANCE [6331] IRS NUMBER: 752069407 STATE OF INCORPORATION: TX FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 2301 HIGHWAY 190 WEST CITY: DERIDDER STATE: LA ZIP: 70634 BUSINESS PHONE: 337-463-9052 MAIL ADDRESS: STREET 1: 2301 HIGHWAY 190 WEST CITY: DERIDDER STATE: LA ZIP: 70634 3 1 edgar.xml PRIMARY DOCUMENT X0202 3 2005-11-17 0 0001018979 AMERISAFE INC AMSF 0001012089 WELSH CARSON ANDERSON & STOWE VII LP ET AL 320 PARK AVENUE SUITE 2500 NEW YORK NY 10022 0 0 1 0 Common Stock 200731 D Series A Preferred Stock 744379 D Jonathan M. Rather, General Partner of WCAS VII Partners, L.P., General Partner of Welsh, Carson, Anderson & Stowe VII, L.P. 2005-11-17 -----END PRIVACY-ENHANCED MESSAGE-----