-----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, NnpS9OISVjJu6CNB0cR1BDePzqz0cO1FtUXpOs3FAU4qRdcznGoL6uXw7ko7aWPu Yq2VoD1CehmPrkm5EwFiJA== 0001209191-07-047360.txt : 20070810 0001209191-07-047360.hdr.sgml : 20070810 20070810121216 ACCESSION NUMBER: 0001209191-07-047360 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20070810 FILED AS OF DATE: 20070810 DATE AS OF CHANGE: 20070810 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: 071043857 BUSINESS ADDRESS: BUSINESS PHONE: (337)463-9052 MAIL ADDRESS: STREET 1: 2301 HIGHWAY 190 WEST CITY: DERIDDER STATE: LA ZIP: 70634-6006 4 1 doc4.xml FORM 4 SUBMISSION X0202 4 2007-08-10 0 0001018979 AMERISAFE INC AMSF 0001391257 Phillips Daniel 2301 HIGHWAY 190 WEST DERIDDER LA 70634 1 0 0 0 Common Stock, par value $.01 per share 2007-08-10 4 P 0 100 13.66 A 949 D Common Stock, par value $.01 per share 2007-08-10 4 P 0 100 13.67 A 1049 D Common Stock, par value $.01 per share 2007-08-10 4 P 0 800 13.68 A 1849 D Common Stock, par value $.01 per share 2007-08-10 4 P 0 500 13.69 A 2349 D /s/ Todd Walker, attorney-in-fact for Daniel Phillips 2007-08-10 -----END PRIVACY-ENHANCED MESSAGE-----