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