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