0001209191-15-043977.txt : 20150518 0001209191-15-043977.hdr.sgml : 20150518 20150518190001 ACCESSION NUMBER: 0001209191-15-043977 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20150514 FILED AS OF DATE: 20150518 DATE AS OF CHANGE: 20150518 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: BRADLEY C ALLEN JR CENTRAL INDEX KEY: 0001341775 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-12251 FILM NUMBER: 15874652 MAIL ADDRESS: STREET 1: AMERISAFE INC STREET 2: 2301 HIGHWAY 190 WEST CITY: DERIDDER STATE: LA ZIP: 70634 4 1 doc4.xml FORM 4 SUBMISSION X0306 4 2015-05-14 0 0001018979 AMERISAFE INC AMSF 0001341775 BRADLEY C ALLEN JR 2301 HIGHWAY 190 WEST DERIDDER LA 70634 1 1 0 0 Chairman and CEO Common stock, par value $0.01 2015-05-14 4 A 0 5956 0.00 A 147818 D Shares issued for the 2012-2014 performance period under an award agreement between the reporting person and the Company pursuant to the Company's Equity and Incentive Compensation Plan. The awards were determined by the Compensation Committee of the Board of Directors of the Company on May 14, 2015 in accordance with the terms of the Plan and the related award agreement. /s/ C. Allen Bradley, Jr. 2015-05-18