0001181431-12-037073.txt : 20120618 0001181431-12-037073.hdr.sgml : 20120618 20120618171258 ACCESSION NUMBER: 0001181431-12-037073 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 2 CONFORMED PERIOD OF REPORT: 20120615 FILED AS OF DATE: 20120618 DATE AS OF CHANGE: 20120618 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Roach Randy CENTRAL INDEX KEY: 0001391169 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-12251 FILM NUMBER: 12913052 MAIL ADDRESS: STREET 1: 2301 HIGHWAY 190 WEST CITY: DERIDDER STATE: LA ZIP: 70634-6006 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 rrd348997.xml 20120615RROACHRESTRICTED X0305 4 2012-06-15 0 0001018979 AMERISAFE INC AMSF 0001391169 Roach Randy 2301 HIGHWAY 190 WEST DERIDDER LA 70634 1 0 0 0 Common Stock, par value $0.01 2012-06-15 4 A 0 1119 0 A 7057 D Common Stock, par value $0.01 200 I Held through Nancy S. Roach IRA Subject to restrictions that will lapse at the time of the 2013 annual shareholder meeting. /s/ Percy McCraney, attorney-in-fact for Randy Roach 2012-06-18 EX-24.1 2 rrd313139_353620.htm POWER OF ATTORNEY OF RANDY ROACH rrd313139_353620.html 
POWER OF ATTORNEY

       	The undersigned hereby constitutes and appoints each of Todd Walker, Percy McCraney, James E.
O?Bannon, Wendy W. Walton, and James D. Litton, or any of them, signing singly, the undersigned?s true
and lawful attorney-in-fact to:


(1)	execute for and on behalf of the undersigned, in the undersigned?s capacity as an officer
and/or director of AMERISAFE, Inc. (the ?Company?), Forms 3,4 and 5 in accordance with
Section 16(a) of the Securities Exchange Act of 1934 and the rules thereunder;


(2)	do and perform any and all acts for and on behalf of the undersigned that may be
necessary or desirable to complete and execute any such Form 3, 4, or 5 and timely file
any such form or forms with the United States Securities and Exchange Commission and
any stock exchange or similar authority; and

(3)	take any other action of any type whatsoever in connection with the foregoing that, in the
opinion of such attorney-in-fact, may be of benefit to, in the best interest of, or legally
required by the undersigned, it being understood that the documents executed by such
attorney-in-fact on behalf of the undersigned pursuant to this power of attorney shall be in
such form and shall contain such terms and conditions as such attorney-in-fact may
approve in such attorney-in-fact's sole discretion.


       	The undersigned hereby grants to each such attorney-in-fact and any of them full power and
authority to do and perform any and every act and deed whatsoever requisite, necessary, or proper to be
done in the exercise of any of the rights and powers herein granted, as fully to all intents and purposes as
the undersigned might or could do if personally present, with full power of substitution or revocation, hereby
ratifying and confirming all that such attorney-in-fact, or such attorney-in-fact's substitute or substitutes, shall
lawfully do or cause to be done by virtue of this power of attorney and the rights and powers herein granted.
The undersigned acknowledges that the foregoing attorneys-in-fact, in serving in such capacity at the
request of the undersigned, are not assuming, nor is the Company assuming, any of the undersigned's
responsibilities to comply with Section 16 of the Securities Exchange Act of 1934.

       	The execution by the undersigned of this power of attorney hereby expressly revokes and
terminates any powers of attorney previously granted by the undersigned relating to Forms 3, 4 and 5. This
power of attorney shall remain in full force and effect until the undersigned is no longer required to file
Forms 3, 4, and 5 with respect to the undersigned's holdings of and transactions in securities issued by the
Company, unless earlier revoked by the undersigned in a signed writing delivered to the foregoing
attorneys-in-fact.

       	IN WITNESS WHEREOF, the undersigned has caused this Power of Attorney to be executed as of
February 23, 2007.


		/s/ Randy Roach