0001209191-17-034544.txt : 20170523
0001209191-17-034544.hdr.sgml : 20170523
20170523072809
ACCESSION NUMBER: 0001209191-17-034544
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20170519
FILED AS OF DATE: 20170523
DATE AS OF CHANGE: 20170523
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: 17862665
MAIL ADDRESS:
STREET 1: 2301 HIGHWAY 190 WEST
CITY: DERIDDER
STATE: LA
ZIP: 70634
4
1
doc4.xml
FORM 4 SUBMISSION
X0306
4
2017-05-19
0
0001018979
AMERISAFE INC
AMSF
0001570960
Gagliano Vincent J.
2301 HIGHWAY 190 WEST
DERIDDER
LA
70634
0
1
0
0
EVP - Chief Risk Officer
Common stock, par value $0.01
2017-05-19
4
A
0
503
0.00
A
21662
D
Shares issued for the 2014-2016 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 19, 2017 in accordance with the terms of the Plan and the related award agreement.
/s/Kathryn H. Shirley, attorney-in-fact for Vincent J. Gagliano
2017-05-23