0001209191-15-070780.txt : 20150915
0001209191-15-070780.hdr.sgml : 20150915
20150915171034
ACCESSION NUMBER: 0001209191-15-070780
CONFORMED SUBMISSION TYPE: 4
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: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-12251
FILM NUMBER: 151108304
MAIL ADDRESS:
STREET 1: C/O SEABRIGHT HOLDINGS, INC.
STREET 2: 1501 4TH AVENUE, SUITE 2600
CITY: SEATTLE
STATE: WA
ZIP: 98101
4
1
doc4.xml
FORM 4 SUBMISSION
X0306
4
2015-09-15
0
0001018979
AMERISAFE INC
AMSF
0001529755
Fuller Neal Andrew
2301 HIGHWAY 190 WEST
DERIDDER
LA
70634
0
1
0
0
EVP-CFO
Common stock, par value $0.01
2015-09-15
4
A
0
25000
0.00
A
25000
D
Restricted shares which vest in five annual installments on a graduated basis of 10%, 15%, 20%, 25% and 30%, beginning September 15, 2016, the first anniversary of the grant date.
/s/ Neal A. Fuller
2015-09-15