0001209191-24-005840.txt : 20240611 0001209191-24-005840.hdr.sgml : 20240611 20240611160912 ACCESSION NUMBER: 0001209191-24-005840 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20240607 FILED AS OF DATE: 20240611 DATE AS OF CHANGE: 20240611 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: BROWN MICHAEL J CENTRAL INDEX KEY: 0001280417 ORGANIZATION NAME: FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-12251 FILM NUMBER: 241035830 MAIL ADDRESS: STREET 1: 200 WEST CONGRESS STREET CITY: LAFAYETTE STATE: LA ZIP: 70501 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: AMERISAFE INC CENTRAL INDEX KEY: 0001018979 STANDARD INDUSTRIAL CLASSIFICATION: FIRE, MARINE & CASUALTY INSURANCE [6331] ORGANIZATION NAME: 02 Finance 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 2024-06-07 0 0001018979 AMERISAFE INC AMSF 0001280417 BROWN MICHAEL J 5 ROSA PARK NEW ORLEANS LA 70115 1 0 0 0 0 Common stock, par value $0.01 2024-06-07 4 A 0 1730 0.00 A 11785 D Subject to restrictions that will lapse at the time of the Issuer's 2025 annual meeting of shareholders. /s/ Kathryn H. Shirley, attorney-in-fact for Michael Brown 2024-06-11