0001209191-23-048379.txt : 20230906 0001209191-23-048379.hdr.sgml : 20230906 20230906161837 ACCESSION NUMBER: 0001209191-23-048379 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20230901 FILED AS OF DATE: 20230906 DATE AS OF CHANGE: 20230906 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Wise Raymond F. Jr. CENTRAL INDEX KEY: 0001691779 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-12251 FILM NUMBER: 231239408 MAIL ADDRESS: STREET 1: 10375 PROFESSIONAL CIRCLE CITY: RENO STATE: NV ZIP: 89521 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 X0508 4 2023-09-01 0 0001018979 AMERISAFE INC AMSF 0001691779 Wise Raymond F. Jr. 2301 HIGHWAY 190 WEST DERIDDER LA 70634 0 1 0 0 EVP - CSO 0 Restricted Stock Unit 2023-09-01 4 A 0 1044 0.00 A Common stock 1044 15232 D Each restricted stock unit represents a contingent right to receive one share of the Issuer's common stock. The restricted stock units fully vest March 1, 2026. /s/Kathryn H. Shirley attorney-in-fact for Raymond F. Wise 2023-09-06