0001209191-23-035773.txt : 20230609 0001209191-23-035773.hdr.sgml : 20230609 20230609161413 ACCESSION NUMBER: 0001209191-23-035773 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20230607 FILED AS OF DATE: 20230609 DATE AS OF CHANGE: 20230609 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Gagliano Vincent J. CENTRAL INDEX KEY: 0001570960 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-12251 FILM NUMBER: 231005415 MAIL ADDRESS: STREET 1: 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 2023-06-07 0 0001018979 AMERISAFE INC AMSF 0001570960 Gagliano Vincent J. 2301 HIGHWAY 190 WEST DERIDDER LA 70634 0 1 0 0 EVP - Chief Risk Officer 0 Common stock, par value $0.01 2023-06-07 4 A 0 3917 0.00 A 23628 D Common stock, par value $0.01 2023-06-07 4 F 0 1708 54.24 D 21920 D /s/Kathryn H. Shirley attorney-in-fact for Vincent J. Gagliano 2023-06-09