0001209191-17-036876.txt : 20170601 0001209191-17-036876.hdr.sgml : 20170601 20170601175656 ACCESSION NUMBER: 0001209191-17-036876 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20170531 FILED AS OF DATE: 20170601 DATE AS OF CHANGE: 20170601 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: GARCIA PHILIP A CENTRAL INDEX KEY: 0001177114 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-12251 FILM NUMBER: 17885871 MAIL ADDRESS: STREET 1: 100 ERIE INSURANCE PL CITY: ERIE STATE: PA ZIP: 16530 4 1 doc4.xml FORM 4 SUBMISSION X0306 4 2017-05-31 0 0001018979 AMERISAFE INC AMSF 0001177114 GARCIA PHILIP A 14791 LAGUNA DRIVE FORT MYERS FL 33908 1 0 0 0 Common stock, par value $0.01 2017-05-31 4 P 0 1554 51.54 A 9558 D /s/ Philip A. Garcia 2017-06-01