0001209191-21-040355.txt : 20210614 0001209191-21-040355.hdr.sgml : 20210614 20210614183710 ACCESSION NUMBER: 0001209191-21-040355 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20210611 FILED AS OF DATE: 20210614 DATE AS OF CHANGE: 20210614 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Morris Millard E CENTRAL INDEX KEY: 0001391161 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-12251 FILM NUMBER: 211016069 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 2021-06-11 0 0001018979 AMERISAFE INC AMSF 0001391161 Morris Millard E 2301 HIGHWAY 190 WEST DERIDDER LA 70634 1 0 0 0 Common stock, par value $0.01 2021-06-11 4 A 0 801 0.00 A 14421 D Common stock, par value $0.01 2000 I Held by Jamem II, Ltd. Common stock, par value $0.01 94220 I Held by Jamem, Ltd. Subject to restrictions that will lapse at the time of the Issuer's 2022 annual meeting of shareholders. /s/Kathryn H. Shirley, attorney-in-fact for Millard E. Morris 2021-06-14