0001209191-15-070637.txt : 20150915 0001209191-15-070637.hdr.sgml : 20150915 20150915111430 ACCESSION NUMBER: 0001209191-15-070637 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20150915 FILED AS OF DATE: 20150915 DATE AS OF CHANGE: 20150915 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: Fuller Neal Andrew CENTRAL INDEX KEY: 0001529755 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-12251 FILM NUMBER: 151107101 MAIL ADDRESS: STREET 1: C/O SEABRIGHT HOLDINGS, INC. STREET 2: 1501 4TH AVENUE, SUITE 2600 CITY: SEATTLE STATE: WA ZIP: 98101 3 1 doc3.xml FORM 3 SUBMISSION X0206 3 2015-09-15 1 0001018979 AMERISAFE INC AMSF 0001529755 Fuller Neal Andrew 2301 HIGHWAY 190 WEST DERIDDER LA 70634 0 1 0 0 EVP-CFO No securities are beneficially owned. /s/ Neal A. Fuller 2015-09-15