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