0001209191-15-053895.txt : 20150616
0001209191-15-053895.hdr.sgml : 20150616
20150616171600
ACCESSION NUMBER: 0001209191-15-053895
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: Roach Randy
CENTRAL INDEX KEY: 0001391169
FILING VALUES:
FORM TYPE: 4/A
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-12251
FILM NUMBER: 15935076
MAIL ADDRESS:
STREET 1: 2301 HIGHWAY 190 WEST
CITY: DERIDDER
STATE: LA
ZIP: 70634-6006
4/A
1
doc4a.xml
FORM 4/A SUBMISSION
X0306
4/A
2015-06-12
2015-06-12
0
0001018979
AMERISAFE INC
AMSF
0001391169
Roach Randy
2301 HIGHWAY 190 WEST
DERIDDER
LA
70634
1
0
0
0
Common stock, par value $0.01
2015-06-12
4
A
0
1016
0.00
A
9780
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 Randall Roach
2015-06-16