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