0001209191-22-036782.txt : 20220614
0001209191-22-036782.hdr.sgml : 20220614
20220614181600
ACCESSION NUMBER: 0001209191-22-036782
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20220610
FILED AS OF DATE: 20220614
DATE AS OF CHANGE: 20220614
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Fontenot Teri G.
CENTRAL INDEX KEY: 0001661066
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-12251
FILM NUMBER: 221016084
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
4
1
doc4.xml
FORM 4 SUBMISSION
X0306
4
2022-06-10
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
2022-06-10
4
A
0
1486
0.00
A
6894
D
Subject to restrictions that will lapse at the time of the Issuer's 2023 annual meeting of shareholders.
/s/Kathryn H. Shirley, attorney-in-fact for Teri G. Fontenot
2022-06-14