0001209191-19-006528.txt : 20190201 0001209191-19-006528.hdr.sgml : 20190201 20190201171754 ACCESSION NUMBER: 0001209191-19-006528 CONFORMED SUBMISSION TYPE: 5 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20181231 FILED AS OF DATE: 20190201 DATE AS OF CHANGE: 20190201 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Fontenot Teri G. CENTRAL INDEX KEY: 0001661066 FILING VALUES: FORM TYPE: 5 SEC ACT: 1934 Act SEC FILE NUMBER: 001-12251 FILM NUMBER: 19560787 MAIL ADDRESS: STREET 1: 18933 EAST PINNACLE CIRCLE CITY: BATON ROUGE STATE: LA ZIP: 70634 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 5 1 doc5.xml FORM 5 SUBMISSION X0306 5 2018-12-31 0 0 0 0001018979 AMERISAFE INC AMSF 0001661066 Fontenot Teri G. 18933 EAST PINNACLE CIRCLE BATON ROUGE LA 70810 1 0 0 0 Common stock, par value $0.01 2018-03-23 5 L 0 4.62 55.55 A 2092.05 D Common stock, par value $0.01 2018-06-22 5 L 0 4.23 60.85 A 2919.28 D Common stock, par value $0.01 2018-09-21 5 L 0 7.23 63.75 A 2926.51 D Common stock, par value $0.01 2018-12-28 5 L 0 141.5 55.30 A 3068.01 D Reporting the purchase of these shares pursuant to Rule 16a-6. /s/Teri G. Fontenot 2019-02-01