0001209191-16-087842.txt : 20160104 0001209191-16-087842.hdr.sgml : 20160104 20160104165215 ACCESSION NUMBER: 0001209191-16-087842 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20160101 FILED AS OF DATE: 20160104 DATE AS OF CHANGE: 20160104 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: Fontenot Teri G. CENTRAL INDEX KEY: 0001661066 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-12251 FILM NUMBER: 161318754 MAIL ADDRESS: STREET 1: 18933 EAST PINNACLE CIRCLE CITY: BATON ROUGE STATE: LA ZIP: 70634 3 1 doc3.xml FORM 3 SUBMISSION X0206 3 2016-01-01 0 0001018979 AMERISAFE INC AMSF 0001661066 Fontenot Teri G. 18933 EAST PINNACLE CIRCLE BATON ROUGE LA 70634 1 0 0 0 Common stock, $0.01 par value 0 D No Issuer securities beneficially owned by reporting person on 1/1/16. /s/ Kathryn H. Shirley, attorney-in-fact for Teri G. Fontenot 2016-01-04