0001209191-17-039587.txt : 20170613
0001209191-17-039587.hdr.sgml : 20170613
20170613172816
ACCESSION NUMBER: 0001209191-17-039587
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20170609
FILED AS OF DATE: 20170613
DATE AS OF CHANGE: 20170613
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: 17909728
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
2017-06-09
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
2017-06-09
4
A
0
922
0.00
A
13312
D
Common stock, par value $0.01
60317
I
Owned by Jared Morris 1997 Trust
Subject to restrictions that will lapse at the time of the Issuer's 2018 annual meeting of shareholders.
/s/Kathryn H. Shirley, attorney-in-fact for Jared A. Morris
2017-06-13