0001209191-19-037528.txt : 20190617 0001209191-19-037528.hdr.sgml : 20190617 20190617191548 ACCESSION NUMBER: 0001209191-19-037528 CONFORMED SUBMISSION TYPE: 4/A PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20190614 FILED AS OF DATE: 20190617 DATE AS OF CHANGE: 20190617 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: BROWN MICHAEL J CENTRAL INDEX KEY: 0001280417 FILING VALUES: FORM TYPE: 4/A SEC ACT: 1934 Act SEC FILE NUMBER: 001-12251 FILM NUMBER: 19902407 MAIL ADDRESS: STREET 1: 200 WEST CONGRESS STREET CITY: LAFAYETTE STATE: LA ZIP: 70501 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/A 1 doc4a.xml FORM 4/A SUBMISSION X0306 4/A 2019-06-14 2019-06-17 0 0001018979 AMERISAFE INC AMSF 0001280417 BROWN MICHAEL J 601 POYDRAS STREET SUITE 2100 NEW ORLEANS LA 70130 1 0 0 0 Common stock, par value $0.01 2019-06-14 4 A 0 815 0.00 A 4636 D Subject to restrictions that will lapse at the time of the Issuer's 2020 annual meeting of shareholders. /s/Kathryn H. Shirley, attorney-in-fact for Michael J. Brown 2019-06-17