0001209191-16-104768.txt : 20160302 0001209191-16-104768.hdr.sgml : 20160302 20160302175351 ACCESSION NUMBER: 0001209191-16-104768 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20160301 FILED AS OF DATE: 20160302 DATE AS OF CHANGE: 20160302 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: Shirley Kathryn Housh CENTRAL INDEX KEY: 0001667972 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-12251 FILM NUMBER: 161478684 MAIL ADDRESS: STREET 1: 2301 HIGHWAY 190 WEST CITY: DERIDDER STATE: LA ZIP: 70634 3 1 doc3.xml FORM 3 SUBMISSION X0206 3 2016-03-01 0 0001018979 AMERISAFE INC AMSF 0001667972 Shirley Kathryn Housh 2301 HIGHWAY 190 WEST DERIDDER LA 70634 0 1 0 0 EVP, General Counsel Common Stock, par value $0.01 13772 D 2,958 restricted shares were awarded May 29, 2012 that ratably vest over five years. 10,000 restricted shares will vest in five annual installments on a graduated basis of 10%, 15%, 20%, 25% and 30% beginning March 1, 2017, the first anniversary of the grant date. 814 restricted shares will fully vest on March 1, 2019. /s/Kathryn H. Shirley 2016-03-02