0001181431-14-024079.txt : 20140624 0001181431-14-024079.hdr.sgml : 20140624 20140616165210 ACCESSION NUMBER: 0001181431-14-024079 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20140613 FILED AS OF DATE: 20140616 DATE AS OF CHANGE: 20140616 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: Phillips Daniel CENTRAL INDEX KEY: 0001391257 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-12251 FILM NUMBER: 14923267 MAIL ADDRESS: STREET 1: 2301 HIGHWAY 190 WEST CITY: DERIDDER STATE: LA ZIP: 70634-6006 4 1 rrd411774.xml FORM 4 X0306 4 2014-06-13 0 0001018979 AMERISAFE INC AMSF 0001391257 Phillips Daniel 2301 HIGHWAY 190 WEST DERIDDER LA 70634 1 0 0 0 Common Stock, par value $0.01 2014-06-13 4 A 0 811 0 A 12722 D Subject to restrictions that will lapse at the time of the 2015 annual meeting of shareholders. /s/ Kathryn H. Rowan, attorney-in-fact for Daniel Phillips 2014-06-16