0001209191-15-079540.txt : 20151112
0001209191-15-079540.hdr.sgml : 20151112
20151112095850
ACCESSION NUMBER: 0001209191-15-079540
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20151109
FILED AS OF DATE: 20151112
DATE AS OF CHANGE: 20151112
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: Gau Brendan
CENTRAL INDEX KEY: 0001466489
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-12251
FILM NUMBER: 151222161
MAIL ADDRESS:
STREET 1: 2301 HIGHWAY 190 WEST
CITY: DERIDDER
STATE: LA
ZIP: 70634
4
1
doc4.xml
FORM 4 SUBMISSION
X0306
4
2015-11-09
0
0001018979
AMERISAFE INC
AMSF
0001466489
Gau Brendan
2301 HIGHWAY 190 WEST
DERIDDER
LA
70634
0
1
0
0
Exec.VP & Chief Investment Of.
Common Stock, par value $0.01
2015-11-09
4
A
0
435
0.00
A
21791
D
Common Stock, par value $0.01
2015-11-09
4
D
0
435
54.00
D
21356
D
Employee Stock Option (right to purchase)
15.60
2015-11-09
4
S
0
435
0.00
D
2012-08-07
2019-08-07
Common stock, par value $0.01 per share
435
34277
D
/s/ Brendan Gau
2015-11-11