0001209191-21-040358.txt : 20210614
0001209191-21-040358.hdr.sgml : 20210614
20210614183859
ACCESSION NUMBER: 0001209191-21-040358
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: Roach Randy
CENTRAL INDEX KEY: 0001391169
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-12251
FILM NUMBER: 211016078
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
0001391169
Roach Randy
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
10262
D
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 Randall E. Roach
2021-06-14