0001209191-15-068268.txt : 20150827
0001209191-15-068268.hdr.sgml : 20150827
20150827173413
ACCESSION NUMBER: 0001209191-15-068268
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20150825
FILED AS OF DATE: 20150827
DATE AS OF CHANGE: 20150827
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: 151079620
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
2015-08-25
0
0001018979
AMERISAFE INC
AMSF
0001341775
BRADLEY C ALLEN JR
2301 HIGHWAY 190 WEST
DERIDDER
LA
70634
1
1
0
0
Executive Chairman
Common Stock, par value $0.01
2015-08-25
4
M
0
54000
7.50
A
198862
D
Employee Stock Option (right to pruchase)
7.50
2015-08-25
4
M
0
54000
0.00
D
2008-11-17
2015-11-17
Common Stock
54000
0
D
/s/ C. Allen Bradley, Jr.
2015-08-27