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