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