0001209191-16-127769.txt : 20160614 0001209191-16-127769.hdr.sgml : 20160614 20160614171913 ACCESSION NUMBER: 0001209191-16-127769 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20160610 FILED AS OF DATE: 20160614 DATE AS OF CHANGE: 20160614 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: MORRIS JARED A CENTRAL INDEX KEY: 0001341776 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-12251 FILM NUMBER: 161713775 MAIL ADDRESS: STREET 1: AMERISAFE INC STREET 2: 2301 HIGHWAY 190 WEST CITY: DERIDDER STATE: LA ZIP: 70634 4 1 doc4.xml FORM 4 SUBMISSION X0306 4 2016-06-10 0 0001018979 AMERISAFE INC AMSF 0001341776 MORRIS JARED A 2301 HIGHWAY 190 WEST DERIDDER LA 70634 1 0 0 0 Common stock, par value $0.01 2016-06-10 4 A 0 697 0.00 A 12390 D Common stock, par value $0.01 57817 I Owned by Jared Morris 1997 Trust Subject to restrictions that will lapse at the time of the Issuer's 2017 annual meeting of shareholders. /s/Kathryn H. Shirley, attorney-in-fact for Jared A. Morris 2016-06-14