0001209191-17-036590.txt : 20170531
0001209191-17-036590.hdr.sgml : 20170531
20170531183710
ACCESSION NUMBER: 0001209191-17-036590
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20170530
FILED AS OF DATE: 20170531
DATE AS OF CHANGE: 20170531
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
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: 17882744
MAIL ADDRESS:
STREET 1: AMERISAFE INC
STREET 2: 2301 HIGHWAY 190 WEST
CITY: DERIDDER
STATE: LA
ZIP: 70634
4
1
doc4.xml
FORM 4 SUBMISSION
X0306
4
2017-05-30
0
0001018979
AMERISAFE INC
AMSF
0001341776
MORRIS JARED A
2301 HIGHWAY 190 WEST
DERIDDER
LA
70634
1
0
0
0
Common stock, par value $0.01
2017-05-30
4
P
0
2500
50.82
A
60317
I
Owned by Jared Morris 1997 Trust
Common stock, par value $0.01
12390
D
Represents the weighted average selling price of the Issuer's common stock. The range of sales prices were between $50.03 and $51.55. The Reporting Person undertakes, upon request, to provide the SEC, the Issuer and any security holder of the Issuer, full information regarding the number of shares sold at each separate price.
/s/Kathryn H. Shirley, attorney-in-fact for Jared A. Morris
2017-05-31