0001181431-12-036959.txt : 20120618 0001181431-12-036959.hdr.sgml : 20120618 20120618121856 ACCESSION NUMBER: 0001181431-12-036959 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20120615 FILED AS OF DATE: 20120618 DATE AS OF CHANGE: 20120618 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Gau Brendan CENTRAL INDEX KEY: 0001466489 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-12251 FILM NUMBER: 12911772 MAIL ADDRESS: STREET 1: 2301 HIGHWAY 190 WEST CITY: DERIDDER STATE: LA ZIP: 70634 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 4 1 rrd348999.xml 20120615BGAULTIPRESTRICTED X0305 4 2012-06-15 0 0001018979 AMERISAFE INC AMSF 0001466489 Gau Brendan 2301 HIGHWAY 190 WEST DERIDDER LA 70634 0 1 0 0 Exec.VP & Chief Investment Of. Common Stock, par value $0.01 2012-06-15 4 A 0 955 0 A 18455 D Restricted shares which fully vest March 22, 2015. /s/ Brendan Gau 2012-06-18