-----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, AKFnjqRtgCsRGODo7kO64Dnp4NUfqybAXHkxKBHd2dKLIfaa16TsGPE+AUpgpJE8 v2717BIr9bEZVAhEyG4YlQ== 0001209191-07-015556.txt : 20070305 0001209191-07-015556.hdr.sgml : 20070305 20070305173221 ACCESSION NUMBER: 0001209191-07-015556 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20070302 FILED AS OF DATE: 20070305 DATE AS OF CHANGE: 20070305 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: Walker Todd Richard CENTRAL INDEX KEY: 0001374459 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-12251 FILM NUMBER: 07672416 BUSINESS ADDRESS: BUSINESS PHONE: (337)463-9052 MAIL ADDRESS: STREET 1: 2301 HWY 190 WEST CITY: DERIDDER STATE: LA ZIP: 70634 4 1 doc4.xml FORM 4 SUBMISSION X0202 4 2007-03-02 0 0001018979 AMERISAFE INC AMSF 0001374459 Walker Todd Richard 2301 HIGHWAY 190 WEST DERIDDER LA 70634 0 1 0 0 Executive VP & General Counsel Employee Stock Option (right to buy) 17.65 2007-03-02 4 A 0 25000 0.00 A 2017-03-02 Common Stock, par value $.01 per share 25000 25000 D Option vests in five equal annual increments beginning on March 2, 2008. /s/ Wendy W. Walton, Attorney-in-Fact for Todd R. Walker, Executive Vice President and General Counsel 2007-03-05 -----END PRIVACY-ENHANCED MESSAGE-----