0001209191-15-053882.txt : 20150616
0001209191-15-053882.hdr.sgml : 20150616
20150616170622
ACCESSION NUMBER: 0001209191-15-053882
CONFORMED SUBMISSION TYPE: 4/A
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20150612
FILED AS OF DATE: 20150616
DATE AS OF CHANGE: 20150616
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: GARCIA PHILIP A
CENTRAL INDEX KEY: 0001177114
FILING VALUES:
FORM TYPE: 4/A
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-12251
FILM NUMBER: 15935013
MAIL ADDRESS:
STREET 1: 100 ERIE INSURANCE PL
CITY: ERIE
STATE: PA
ZIP: 16530
4/A
1
doc4a.xml
FORM 4/A SUBMISSION
X0306
4/A
2015-06-12
2015-06-12
0
0001018979
AMERISAFE INC
AMSF
0001177114
GARCIA PHILIP A
8877 NEW CASTLE DRIVE
8877 NEW CASTLE DRIVE
FL
33908
1
0
0
0
Common Stock, par value $0.01
2015-06-12
4
A
0
1016
0.00
A
7307
D
This amendment is being filed to correct the number of shares automatically granted to the Reporting Person pursuant to the terms of the AMERISAFE Non-Employee Director Restricted Stock Plan on June 12, 2015, the date of the annual meeting of shareholders. 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 Philip A. Garcia
2015-06-16