0001209191-15-052924.txt : 20150612 0001209191-15-052924.hdr.sgml : 20150612 20150612180015 ACCESSION NUMBER: 0001209191-15-052924 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20150612 FILED AS OF DATE: 20150612 DATE AS OF CHANGE: 20150612 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: YOUNG AUSTIN P CENTRAL INDEX KEY: 0001021469 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-12251 FILM NUMBER: 15929604 MAIL ADDRESS: STREET 1: 6200 ARNOT CITY: HOUSTON STATE: TX ZIP: 77007 4 1 doc4.xml FORM 4 SUBMISSION X0306 4 2015-06-12 0 0001018979 AMERISAFE INC AMSF 0001021469 YOUNG AUSTIN P 2301 HIGHWAY 190 WEST DERIDDER LA 70634 1 0 0 0 Common Stock, par value $0.01 2015-06-12 4 A 0 677 0.00 A 2878 D Common Stock, par value $0.01 6827 I Owned through Young 1999 Family Limited Liability Partnership Subject to restrictions that will lapse at the time of the Issuer's 2016 annual meeting of shareholders. /s/ Kathryn H. Shirley, attorney-in-fact for Austin P. Young, III 2015-06-12