0001209191-16-102558.txt : 20160225
0001209191-16-102558.hdr.sgml : 20160225
20160225191232
ACCESSION NUMBER: 0001209191-16-102558
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20160223
FILED AS OF DATE: 20160225
DATE AS OF CHANGE: 20160225
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: Gagliano Vincent J.
CENTRAL INDEX KEY: 0001570960
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-12251
FILM NUMBER: 161457496
MAIL ADDRESS:
STREET 1: 2301 HIGHWAY 190 WEST
CITY: DERIDDER
STATE: LA
ZIP: 70634
4
1
doc4.xml
FORM 4 SUBMISSION
X0306
4
2016-02-23
0
0001018979
AMERISAFE INC
AMSF
0001570960
Gagliano Vincent J.
2301 HIGHWAY 190 WEST
DERIDDER
LA
70634
0
1
0
0
EVP - Chief Technology Officer
Common stock, par value $0.01
2016-02-23
4
A
0
930
0.00
A
26144
D
Restricted shares which fully vest on March 1, 2019.
/s/Vincent J. Gagliano
2016-02-25