0001209191-22-048627.txt : 20220906
0001209191-22-048627.hdr.sgml : 20220906
20220906071443
ACCESSION NUMBER: 0001209191-22-048627
CONFORMED SUBMISSION TYPE: 4
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: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-12251
FILM NUMBER: 221226845
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
4
1
doc4.xml
FORM 4 SUBMISSION
X0306
4
2022-09-01
0
0001018979
AMERISAFE INC
AMSF
0001789494
Omiridis Anastasios
2301 HIGHWAY 190 WEST
DERIDDER
LA
70634
0
1
0
0
EVP-CFO
Restricted Stock Units
2022-09-01
4
A
0
22826
0.00
A
Common stock
22826
22826
D
Each restricted stock unit represents a contingent right to receive one share of the Issuer's common stock.
The restricted stock units vest in four annual installments of 35%, 15%, 20% and 30% beginning September 1, 2023, the first anniversary of the grant date.
/s/Kathryn H. Shirley, attorney-in-fact for Anastasios Omiridis
2022-09-06