0001209191-16-102635.txt : 20160225 0001209191-16-102635.hdr.sgml : 20160225 20160225215529 ACCESSION NUMBER: 0001209191-16-102635 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: Fuller Neal Andrew CENTRAL INDEX KEY: 0001529755 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-12251 FILM NUMBER: 161457796 MAIL ADDRESS: STREET 1: C/O SEABRIGHT HOLDINGS, INC. STREET 2: 1501 4TH AVENUE, SUITE 2600 CITY: SEATTLE STATE: WA ZIP: 98101 4 1 doc4.xml FORM 4 SUBMISSION X0306 4 2016-02-23 0 0001018979 AMERISAFE INC AMSF 0001529755 Fuller Neal Andrew 2301 HIGHWAY 190 WEST DERIDDER LA 70634 0 1 0 0 EVP-CFO Common Stock, par value $0.01 2016-02-23 4 A 0 1260 0.00 A 26260 D Restricted shares which fully vest on March 1, 2019. /s/ Neal Fuller 2016-02-25