0001209191-19-032115.txt : 20190522 0001209191-19-032115.hdr.sgml : 20190522 20190522171038 ACCESSION NUMBER: 0001209191-19-032115 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20190520 FILED AS OF DATE: 20190522 DATE AS OF CHANGE: 20190522 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: McCray Andrew B. CENTRAL INDEX KEY: 0001777423 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-12251 FILM NUMBER: 19846704 MAIL ADDRESS: STREET 1: 2301 HIGHWAY 27 CITY: DERIDDER 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 4 1 doc4.xml FORM 4 SUBMISSION X0306 4 2019-05-20 0 0001018979 AMERISAFE INC AMSF 0001777423 McCray Andrew B. 2301 HIGHWAY 190 WEST DERIDDER LA 70634 0 1 0 0 EVP-CUO Common stock, par value $0.01 2019-05-20 4 A 0 9000 0.00 A 9000 D Restricted shares which vest in five annual installments on a graduated basis of 10%, 15%, 25%, and 30%, beginning May 20, 2020, the first anniversary of the grant date. /s/Kathryn H. Shirley, attorney-in-fact for Andrew B. McCray 2019-05-22