0001181431-13-037182.txt : 20130628 0001181431-13-037182.hdr.sgml : 20130628 20130628122135 ACCESSION NUMBER: 0001181431-13-037182 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20130614 FILED AS OF DATE: 20130628 DATE AS OF CHANGE: 20130628 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 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: YOUNG AUSTIN P CENTRAL INDEX KEY: 0001021469 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-12251 FILM NUMBER: 13939757 MAIL ADDRESS: STREET 1: 6200 ARNOT CITY: HOUSTON STATE: TX ZIP: 77007 4 1 rrd384590.xml FORM 4 X0306 4 2013-06-14 0 0001018979 AMERISAFE INC AMSF 0001021469 YOUNG AUSTIN P 2301 HIGHWAY 190 WEST DERIDDER LA 70634 1 0 0 0 Common Stock, par value $0.01 2013-06-14 4 A 0 896 0 A 6286 D Common stock, par value $0.01 5931 I Owned through Young 1999 Family Limited Liability Parthership Subject to restrictions that will lapse at the time of the Issuer's 2014 annual meeting of shareholders. Excludes 3,247 shares previously owned directly which were transferred to the family limited partnership on January 26, 2011. /s/Kathryn H. Rowan, attorney-in-fact for Austin P. Young, III 2013-06-28