0001209191-16-123320.txt : 20160525 0001209191-16-123320.hdr.sgml : 20160525 20160525175959 ACCESSION NUMBER: 0001209191-16-123320 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20160525 FILED AS OF DATE: 20160525 DATE AS OF CHANGE: 20160525 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: Frost G. Janelle CENTRAL INDEX KEY: 0001449515 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-12251 FILM NUMBER: 161675693 MAIL ADDRESS: STREET 1: 2301 HIGHWAY 190 WEST CITY: DERIDDER STATE: LA ZIP: 70634 4 1 doc4.xml FORM 4 SUBMISSION X0306 4 2016-05-25 0 0001018979 AMERISAFE INC AMSF 0001449515 Frost G. Janelle 2301 HIGHWAY 190 WEST DERIDDER LA 70634 0 1 0 0 President & CEO Common stock, par value $0.01 2016-05-25 4 A 0 820 0.00 A 50321 D Shares issued for the 2013-2015 performance period under an award agreement between the reporting person and the Company pursuant to the Company's Equity and Incentive Compensation Plan. The awards were determined by the Compensation Committee of the Board of Directors of the Company on May 25, 2016 in accordance with the terms of the Plan and the related award agreement. /s/ G. Janelle Frost 2016-05-25