0001209191-24-005844.txt : 20240611 0001209191-24-005844.hdr.sgml : 20240611 20240611161400 ACCESSION NUMBER: 0001209191-24-005844 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: MORRIS JARED A CENTRAL INDEX KEY: 0001341776 ORGANIZATION NAME: FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-12251 FILM NUMBER: 241035916 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] 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 0001341776 MORRIS JARED A 2301 HIGHWAY 190 WEST DERIDDER LA 70634 1 0 0 0 0 Common stock, par value $0.01 2024-06-07 4 A 0 1730 0.00 A 21099 D Common stock, par value $0.01 61353 I Owned by Jared Morris 1997 Trust 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 Jared A. Morris 2024-06-11