0001209191-20-035050.txt : 20200608 0001209191-20-035050.hdr.sgml : 20200608 20200608174435 ACCESSION NUMBER: 0001209191-20-035050 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20200605 FILED AS OF DATE: 20200608 DATE AS OF CHANGE: 20200608 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: BROWN MICHAEL J CENTRAL INDEX KEY: 0001280417 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-12251 FILM NUMBER: 20950207 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] 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 X0306 4 2020-06-05 0 0001018979 AMERISAFE INC AMSF 0001280417 BROWN MICHAEL J 601 POYDRAS STREET SUITE 2100 NEW ORLEANS LA 70130 1 0 0 0 Common stock, par value $0.01 2020-06-05 4 A 0 724 0.00 A 5360 D Subject to restrictions that will lapse at the time of the Issuer's 2021 annual meeting of shareholders. /s/Kathryn H. Shirley, attorney-in-fact for Michael J. Brown 2020-06-08