0001209191-16-089578.txt : 20160106
0001209191-16-089578.hdr.sgml : 20160106
20160106114600
ACCESSION NUMBER: 0001209191-16-089578
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20160104
FILED AS OF DATE: 20160106
DATE AS OF CHANGE: 20160106
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: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-12251
FILM NUMBER: 161325852
MAIL ADDRESS:
STREET 1: 18933 EAST PINNACLE CIRCLE
CITY: BATON ROUGE
STATE: LA
ZIP: 70634
4
1
doc4.xml
FORM 4 SUBMISSION
X0306
4
2016-01-04
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
2016-01-04
4
A
0
376
0.00
A
376
D
Subject to restrictions that will lapse at the time of the Issuer's 2016 annual meeting of shareholders.
/s/Kathryn H. Shirley attorney-in-fact for Teri G. Fontenot
2016-01-06