0001209191-17-048421.txt : 20170810
0001209191-17-048421.hdr.sgml : 20170810
20170810162203
ACCESSION NUMBER: 0001209191-17-048421
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20170809
FILED AS OF DATE: 20170810
DATE AS OF CHANGE: 20170810
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Roach Randy
CENTRAL INDEX KEY: 0001391169
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-12251
FILM NUMBER: 171021717
MAIL ADDRESS:
STREET 1: 2301 HIGHWAY 190 WEST
CITY: DERIDDER
STATE: LA
ZIP: 70634-6006
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
4
1
doc4.xml
FORM 4 SUBMISSION
X0306
4
2017-08-09
0
0001018979
AMERISAFE INC
AMSF
0001391169
Roach Randy
2301 HIGHWAY 190 WEST
DERIDDER
LA
70634
1
0
0
0
Common stock, par value $0.01
2017-08-09
4
S
0
500
56.90
D
8399
D
/s/Kathryn H. Shirley, attorney-in-fact for Randall Roach
2017-08-10