0001209191-22-036784.txt : 20220614 0001209191-22-036784.hdr.sgml : 20220614 20220614181826 ACCESSION NUMBER: 0001209191-22-036784 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: GARCIA PHILIP A CENTRAL INDEX KEY: 0001177114 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-12251 FILM NUMBER: 221016089 MAIL ADDRESS: STREET 1: 100 ERIE INSURANCE PL CITY: ERIE STATE: PA ZIP: 16530 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 0001177114 GARCIA PHILIP A 5997 CYPRESS LANE BONITA SPRINGS FL 34134 1 0 0 0 Common stock par value $0.01 2022-06-10 4 A 0 1486 0.00 A 20129 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 Philip A. Garcia 2022-06-14