0001209191-23-030003.txt : 20230517 0001209191-23-030003.hdr.sgml : 20230517 20230517071703 ACCESSION NUMBER: 0001209191-23-030003 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20230516 FILED AS OF DATE: 20230517 DATE AS OF CHANGE: 20230517 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: MORRIS JARED A CENTRAL INDEX KEY: 0001341776 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-12251 FILM NUMBER: 23929626 MAIL ADDRESS: STREET 1: AMERISAFE INC STREET 2: 2301 HIGHWAY 190 WEST CITY: DERIDDER STATE: LA ZIP: 70634 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 X0407 4 2023-05-16 0 0001018979 AMERISAFE INC AMSF 0001341776 MORRIS JARED A 2301 HIGHWAY 190 WEST DERIDDER LA 70634 1 0 0 0 0 Common stock, par value $0.01 2023-05-16 4 J 0 1036 0.00 A 61353 I Owned by Jared Morris 1997 Trust Shares received from partnership distribution without consideration. The per share carryover tax basis is $15.74 per share. /s/Kathryn H. Shirley attorney-in-fact for Jared A. Morris 2023-05-17