0001209191-22-048625.txt : 20220906 0001209191-22-048625.hdr.sgml : 20220906 20220906070756 ACCESSION NUMBER: 0001209191-22-048625 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20220901 FILED AS OF DATE: 20220906 DATE AS OF CHANGE: 20220906 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Omiridis Anastasios CENTRAL INDEX KEY: 0001789494 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-12251 FILM NUMBER: 221226839 MAIL ADDRESS: STREET 1: 200 EAST RANDOLPH STREET STREET 2: SUITE 3300 CITY: CHICAGO STATE: IL ZIP: 60601 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 3 1 doc3.xml FORM 3 SUBMISSION X0206 3 2022-09-01 1 0001018979 AMERISAFE INC AMSF 0001789494 Omiridis Anastasios 2301 HIGHWAY 190 WEST DERIDDER LA 70634 0 1 0 0 EVP-CFO /s/Kathryn H. Shirley attorney-in-fact for Anastasios Omiridis 2022-09-06