-----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, BeH+yANSkmO5f02cLSrkgHRRe0JMOMgfBWCM/JFaKc42kJ6veA8PeiaZdmEYeBQj 0UCyHHrDPPC8+bz4ndqXng== 0001209191-05-058542.txt : 20051121 0001209191-05-058542.hdr.sgml : 20051121 20051121095958 ACCESSION NUMBER: 0001209191-05-058542 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20051118 FILED AS OF DATE: 20051121 DATE AS OF CHANGE: 20051121 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: BRADLEY C ALLEN JR CENTRAL INDEX KEY: 0001341775 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-12251 FILM NUMBER: 051216783 BUSINESS ADDRESS: BUSINESS PHONE: 337-463-9052 MAIL ADDRESS: STREET 1: AMERISAFE INC STREET 2: 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 doc4.xml FORM 4 SUBMISSION X0202 4 2005-11-18 0 0001018979 AMERISAFE INC AMSF 0001341775 BRADLEY C ALLEN JR 2301 HIGHWAY 190 WEST DERIDDER LA 70634 1 1 0 0 Chairman, President and CEO Common Stock, par value $.01 per share 2005-11-18 4 P 0 15000 9.00 A 15394 D /s/ Larry D. Cannon Larry D. Cannon, Attorney-in-Fact for C. Allen Bradley, Jr., Chairman, President and Chief Executive Officer 2005-11-21 -----END PRIVACY-ENHANCED MESSAGE-----